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DOI: 10.1055/s-0029-1185767
© Georg Thieme Verlag KG Stuttgart · New York
Surgical Management of Secondary Spontaneous Pneumothorax in Elderly Patients with Chronic Obstructive Pulmonary Disease: Retrospective Study of 107 Cases
Publikationsverlauf
received Sept. 11, 2008
Publikationsdatum:
25. August 2009 (online)
![](https://www.thieme-connect.de/media/thoracic/200906/lookinside/thumbnails/10.1055-s-0029-1185767-1.jpg)
Abstract
Background: Aim of the study was to assess the results of surgery for secondary spontaneous pneumothorax (SSP) in the elderly with COPD at Shanghai Pulmonary Disease Hospital. Methods: From 1 January 1993 to 30 June 2007, the operation for SSP was performed in 107 elderly patients (≥ 60y) with COPD. All patient data was reviewed retrospectively. Results: Morbidity was 25.2 % and mortality was 4.7 %. The total effective rate of intrapleural injection of human fibrinogen for the treatment of postoperative persistent air leaks was 86.7 %. Multivariate analyses of postoperative air leaks suggest that patients undergoing pleurodesis (OR 0.189, 95 % CI 0.045–0.790, p = 0.022) have a decreased risk of postoperative air leaks. Multivariate analyses of postoperative complications suggest that patients with higher PaCO2 (OR 0.890, 95 % CI 0.814–0.973, p = 0.011) have an increased risk and patients undergoing pleurodesis (OR 4.319, 95 % CI 1.398–13.349, p = 0.011) have a decreased risk. Conclusions: Surgical intervention is recommended in selected elderly COPD patients with SSP, with hypercapnia known as an operative contraindication. Additionally, surgery offers the advantage of intraoperative pleurodesis for the prevention of prolonged postoperative air leaks, while intrapleural injection of human fibrinogen is an effective procedure in the treatment of air leaks.
Key words
pneumothorax - elderly - surgery
References
- 1 Gupta D, Hansell A, Nichols T, Duong T, Ayres J G, Strachan D. Epidemiology of pneumothorax in England. Thorax. 2000; 55 666-671
- 2 Wait M A, Estrera A. Changing clinical spectrum of spontaneous pneumothorax. Am J Surg. 1992; 164 528-531
- 3 Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003; 58 (Suppl. 2) ii39-ii52
- 4 Baumann M H, Strange C, Heffner J E, Light R, Kirby T J, Klein J, Luketich J D, Panacek E A, Sahn S A. AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001; 119 590-602
- 5 Tschopp J M, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J. 2006; 28 637-650
- 6 Limthongkul S, Wongthim S, Udompanich V, Charoenlap P, Nuchprayoon C. Spontaneous pneumothorax in chronic obstructive pulmonary disease. J Med Assoc Thai. 1992; 75 204-212
- 7 Takigawa N, Tada A, Soda R, Date H, Yamashita M, Endo S, Takahashi S, Kawata N, Shibayama T, Hamada N, Sakaguchi M, Hirano A, Kimura G, Okada C, Takahashi K. Distance and oxygen desaturation in 6-min walk test predict prognosis in COPD patients. Respir Med. 2007; 101 561-567
- 8 Waller D A, McConnell S A, Rajesh P B. Delayed referral reduces the success of video-assisted thoracoscopic surgery for spontaneous pneumothorax. Respir Med. 1998; 92 246-249
- 9 Schramel F M, Sutedja T G, Braber J C, van Mourik J C, Postmus P E. Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax. Eur Respir J. 1996; 9 1821-1825
- 10 Lippert H L, Lund O, Blegvad S, Larsen H V. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J. 1991; 4 324-331
- 11 Sahn S A, Heffner J E. Primary care: spontaneous pneumothorax. N Engl J Med. 2000; 342 868-874
- 12 Ng C S, Lee T W, Wan S, Yim A P. Video assisted thoracic surgery in the management of spontaneous pneumothorax: the current status. Postgrad Med J. 2006; 82 179-185
- 13 Melvin W S, Krasna M J, McLaughlin J S. Thoracoscopic management of spontaneous pneumothorax. Chest. 1992; 102 1877-1879
- 14 Hatz R A, Kaps M F, Meimarakis G, Loehe F, Müller C, Fürst H. Long-term results after video-assisted thoracoscopic surgery for first time and recurrent spontaneous pneumothorax. Ann Thorac Surg. 2000; 70 253-257
- 15 Passlick B, Born C, Häussinger K, Thetter O. Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg. 1998; 65 324-327
- 16 Rieger R, Woisetschläger R, Schrenk P, Wayand W. Thoracoscopic bleb resection selectively combined with pleurectomy for complicated spontaneous pneumothorax. Eur J Surg. 1998; 164 333-338
- 17 Horio H, Nomori H, Fuyuno G, Kobayashi R, Suemasu K. Limited axillary thoracotomy vs. video-assisted thoracoscopic surgery for spontaneous pneumothorax. Surg Endosc. 1998; 12 1155-1158
- 18 Gebhard F T, Becker H P, Gerngross H, Brückner U B. Reduced inflammatory response in minimally invasive surgery of pneumothorax. Arch Surg. 1996; 131 1079-1082
- 19 Andres B, Lujan J, Robles R, Aguilar J, Flores B, Parrilla P. Treatment of primary and secondary spontaneous pneumothorax using video-thoracoscopy. Surg Laparosc Endosc. 1998; 8 108-112
- 20 Athanassiadi K, Kalavrouziotis G, Loutsidis A, Hatzimichalis A, Bellenis I, Exarchos N. Surgical treatment of spontaneous pneumothorax: ten-year experience. World J Surg. 1998; 22 803-806
- 21 Muramatsu T, Ohmori K, Shimamura M, Furuichi M, Takeshita S, Negishi N. Staple line reinforcement with fleece-coated fibrin glue (TachoComb) after thoracoscopic bullectomy for the treatment of spontaneous pneumothorax. Surg Today. 2007; 37 745-749
- 22 Canonico S. The use of human fibrin glue in the surgical operations. Acta Biomed. 2003; 74 (Suppl. 2) 21-25
- 23 Cetin B, Atalay C, Arzu Koçkaya E, Turan Akay M. The efficacy of fibrin tissue adhesives in pleurodesis in rats. Exp Lung Res. 2005; 31 713-718
Dr. Yi Zhang
Department of Thoracic Surgery
Shanghai Pulmonary Disease Hospital affiliated to Tongji University
507 Zheng Min Road
200433 Shanghai
P. R. China
Telefon: + 86 0 21 65 11 50 06
eMail: yeechang120@yahoo.com.cn