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PRZEGLD CHIRURGICZNY
2013, 85, 1, 1219
10.2478/pjs-2013-0003
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G. Tomczyk et al.
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right (n)
left (n)
Mean stay in ahospital during the first episode of
pneumothorax (days)
Mean duration of drainage during the first episode of
pneumothorax (days)
Mean duration of drainage during the recurrent
pneumothorax (days)
Mean interval between the first episode and recurrence
of pneumothorax
Recurrent pneumothorax after treatment
yes (n)
no (n)
Pneumothorax on the other side
yes (n)
no (n)
Fear of recurrent pneumothorax
yes (n)
no (n)
rence of pneumothorax, pleurodesis was performed in 36% vs. 63% without a recurrence
of the pneumothorax. While analysing the
questionnaire results it was found that 70% of
non-surgically treated patients (n=21) were
afraid of pneumothorax recurrence. 50% of
patients (n=12) in a group of operated patients
feel such a fear. This difference is statistically
significant (p=0.01). Among eleven patients
with the first recurrence of pneumothorax
treated with drainage only (nosurgery), nine
underwent surgery at the second episode of
recurrence (6 via videothoracoscopic approach
and 3 thoracotomy). Among two other patients, one did not give their consent to the
proposed surgical procedure and the second
was disqualified due to the concomitant diseases. These patients were treated with a
pleural drainage again.
DISCUSSION
The primary spontaneous pneumothorax is
a common clinical problem with an increasing
incidence trend (1). A risk of disease recurrence
is high and it ranges, according to various
sources, from 20 to 60% (2, 3). The recurrence
frequency amounted to 42.5% in the material
of the Wrocaw Thoracic Surgery Centre
(WOT). Therefore, a high percentage of a recurrent spontaneous pneumothorax creates a
Treatment method
p
surgical treatment
nonsurgical treatment
n=24
n=30
42,5
53,6
0,012
12
18
0,23
12
12
7,31,81
6,92,03
0,38
(5-10)
(4-14)
5,31,40
5,51,58
0,52
(3-9)
(3-10)
6,451,82
6,93,51
0,57
(3-10)
(3-20)
665
398
0,05
(3-2920)
(4-1825)
0
11
0,0009
24
19
0
3
0,11
24
27
12
21
0,01
12
9
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G. Tomczyk et al.
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Centre was performed with both an open thoracotomy and via videothoracoscopic approach.
Since January 2010 the recurrent non-complicated pneumothorax has been treated via videothoracoscopic approach as a rule, and the
percentage of conversion to thoracotomy is low
(2-5%) and most commonly caused by intraoperative adhesions in the pleural cavity or a intraoperative haemorrhage (12). According to
the opinion of the Wrocaw Thoracic Surgery
Centres physicians, video-assisted thoracoscopy provides as good evaluation and access to
an operated area as a classic thoracotomy enabling also a very good visualisation of the
pathological changes (multiple image magnification), smaller operative trauma as well as a
shorter stay in the hospital in comparison to a
classic thoracotomy. While analysing the studied patients population it should be noted that
despite the significance of individual choice of
treatment for each patient (including clinical
symptoms, presence of air leak, pneumothorax
size) a surgical treatment at first disease recurrence is the most effective.
The results show that the performance of
drainageonly in the recurrence of pneumothorax is an ineffective treatment, and in the case
of disqualification or lack of patients consent
to a surgery, the drainage should be supplemented with a chemical pleurodesis of a pleural cavity. Since most of pleurodesis procedures
were, according to the analysed material, performed withdoxycyclinum (75%) it seems to be
a sufficiently effective remedy to prevent pneumothorax recurrences.
In the group of 30 patients where a pneumothorax recurrence was treated with drainage, subsequent pneumothorax recurrence in
11 patients was found. Among these persons,
9 patients underwent a surgery. Pleural cavity drainage was used in two patients again.
No subsequent pneumothorax recurrences
were noted in the observed period in the group
of 11 patients who were described above. According to our observations, the patients with
the first pneumothorax recurrence treated
with another drainage, are treated surgically
at the disease recurrence anyway. This is consistent with the literature data (13) according
to which application of a drain alone into a
pleural cavity does not effectively prevent recurrence of pneumothorax.
By observing the population of patients who
are treated for pneumothorax, regardless of
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G. Tomczyk et al.
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Received: 8.01.2013r.
Adress correspondence: 53-439 Wrocaw, ul. Grabiszyska 105
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