Escolar Documentos
Profissional Documentos
Cultura Documentos
Shaikhrezai (2010) 89 (94 operations) 19.2 2.1 3.9 1.1% Median: 73 months
Current study 95 (97 operations) 20.6 4.1 9.3 44.3% Median: 24 months
a
Early revisional thoracotomy for postoperative persistent air leak.
b
Initial open thoracotomy.
O
R
I
G
I
N
A
L
A
R
T
I
C
L
E
M. Isaka et al. / Interactive CardioVascular and Thoracic Surgery 251
sclerosing agents, for example OK-432, resulted in clumsiness
during surgery due to being liquid solutions. Moreover mechanic-
al pleurodesis, for example pleurectomy, is not often performed
because of the possibility that mechanical pleurodesis results in
postoperative complications such as bleeding. There was no signi-
cant difference in recurrence rates, whether chemical pleurodesis
was used or not; however, no recurrence was seen in the patients
who underwent chemical pleurodesis. Although the usage of
pleurodesis in combination with surgery or by itself is the subject
of future investigation, the treatment is an important option for
patients with SSP, particularly those who are considered to be at
risk in surgery.
In conclusion, surgical treatment in patients with SSP had fa-
vourable results. This study suggested that, when safe stapling of
the bulla is feasible, surgical treatment for SSP should be per-
formed aggressively in terms of pursuing a radical cure. However,
patients for whom the base of the bulla is judged as untreatable
with staplers, with signicant emphysematous change on pre-
operative CT image and pulmonary brosis, should be investi-
gated for the indications for surgery and additional treatments
such as pleurodesis because of their high morbidity and recur-
rence rates.
Conict of interest: none declared.
REFERENCES
[1] Nakajima J. Surgery for secondary spontaneous pneumothorax. Curr Opin
Pulm Med 2010;16:37680.
[2] Asai K, Urabe N. Secondary spontaneous pneumothorax associated with
emphysema and ruptured bullae at the azygoesophageal recess. Gen
Thorac Cardiovasc Surg 2008;56:53943.
[3] Guo Y, Xie C, Rodriguez RM, Light RW. Factors related to recurrence of
spontaneous pneumothorax. Respirology 2005;10:37884.
[4] Lippert HL, Lund O, Blegvad S, Larsen HV. Independent risk factors for cu-
mulative recurrence rate after rst spontaneous pneumothorax. Eur Respir
J 1991;4:32431.
[5] Goddard PR, Nicholson EM, Laszlo G, Watt I. Computed tomography in
pulmonary emphysema. Clin Radiol 1982;33:37987.
[6] Hunsaker AR, Ingenito EP, Reilly JJ, Costello P. Lung volume reduction
surgery for emphysema: correlation of CT and V/Q imaging with physiologic
mechanisms of improvement in lung function. Radiology 2002;222:4918.
[7] Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000;342:
86874.
[8] Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E.
Spontaneous pneumothorax in chronic obstructive pulmonary disease:
complications, treatment and recurrences. Eur J Respir Dis 1987;71:
36571.
[9] Schoenenberger RA, Haefeli WE, Weiss P, Ritz RF. Timing of invasive pro-
cedures in therapy for primary and secondary spontaneous pneumo-
thorax. Arch Surg 1991;126:7646.
[10] Nakajima J, Takamoto S, Murakawa T, Fukami T, Yoshida Y, Kusakabe M.
Outcomes of thoracoscopic management of secondary pneumothorax in
patients with COPD and interstitial pulmonary brosis. Surg Endosc 2009;
23:153640.
[11] Onuki T, Murasugi M, Ikeda T, Oyama K, Nitta S. Thoracoscopic surgery for
pneumothorax in older patients. Surg Endosc 2002;16:3557.
[12] Passlick B, Born C, Haussinger K, Thetter O. Efciency of video-assisted
thoracic surgery for primary and secondary spontaneous pneumothorax.
Ann Thorac Surg 1998;65:3247.
[13] Qureshi R, Nugent A, Hayat J, Qureshi M, Norton R. Should surgical pleur-
ectomy for spontaneous pneumothorax be always thoracoscopic? Interact
Cardiovasc Thorac Surg 2008;7:56972.
[14] Shaikhrezai K, Thompson AI, Parkin C, Stamenkovic S, Walker WS.
Video-assisted thoracoscopic surgery management of spontaneous
pneumothorax-long-term results. Eur J Cardiothorac Surg 2011;40:12023.
[15] Tanaka F, Itoh M, Esaki H, Isobe J, Ueno Y, Inoue R. Secondary spontan-
eous pneumothorax. Ann Thorac Surg 1993;55:3726.
[16] Waller DA. Video-assisted thoracoscopic surgery for spontaneous
pneumothoraxa 7-year learning experience. Ann R Coll Surg Engl 1999;
81:38792.
[17] Waller DA, Forty J, Soni AK, Conacher ID, Morritt GN. Videothoracoscopic
operation for secondary spontaneous pneumothorax. Ann Thorac Surg
1994;57:16125.
[18] Zhang Y, Jiang G, Chen C, Ding J, Zhu Y, Xu Z. Surgical management of
secondary spontaneous pneumothorax in elderly patients with chronic
obstructive pulmonary disease: retrospective study of 107 cases. Thorac
Cardiovasc Surg 2009;57:34752.
[19] Cardillo G, Facciolo F, Giunti R, Gasparri R, Lopergolo M, Orsetti R et al.
Videothoracoscopic treatment of primary spontaneous pneumothorax: a
6-year experience. Ann Thorac Surg 2000;69:35761; discussion 612.
[20] Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J
et al. Management of spontaneous pneumothorax: an American
College of Chest Physicians Delphi consensus statement. Chest 2001;119:
590602.
[21] Barker A, Maratos EC, Edmonds L, Lim E. Recurrence rates of video-
assisted thoracoscopic versus open surgery in the prevention of recurrent
pneumothoraces: a systematic review of randomised and non-rando-
mised trials. Lancet 2007;370:32935.
[22] Lee P, Yap WS, Pek WY, Ng AW. An Audit of medical thoracoscopy and talc
poudrage for pneumothorax prevention in advanced COPD. Chest 2004;
125:131520.
[23] Ng CK, Ko FW, Chan JW, Yeung A, Yee WK, So LK et al. Minocycline and
talc slurry pleurodesis for patients with secondary spontaneous pneumo-
thorax. Int J Tuberc Lung Dis 2010;14:13426.
M. Isaka et al. / Interactive CardioVascular and Thoracic Surgery 252