| Objective: To evaluate the efficacy and safety of localization technique with double-lumen balloon floating catheter (Swan-Ganz catheter) under the lead of bronchofibroscope in the treatment of pneumothorax, comparing with the catheter special for bronchofibroscope (Fogarty catheter).Methods: 60 patients with pneumatothorax were studied from November 2001 to November 2006. male 53 and female 7, ages ranging from 19 to 70 years old and the average age was 40±14. The selecting standards: (1) all the patients were suffered with spontaneous pneumothorax; (2) after the treatment of closed drainage of thoracic cavity for 1 week but had no effect, and willingly accepted the treatment of Swan-Ganz catheter;(3) without serious functional disorder of heart and lung system; (4) without the contraindications of bronchofiberscopy. These 60 patients include 33 idiopathic pneumothorax, 27 secondary pneumothorax. Among the patients with secondary pneumothorax, chronic obstructive pulmonary disease was 14, bronchiectasia was 3, lung cancer was 5, obsolete pneumonophthisis was 4 and others was 1. Pneumatothorax type: closed pneumothorax 41, open pneumothorax 14 and tension pneumothorax 5.Experiment equipment: (1)Swan-Ganz catheter, outer diameter is 5～9F, length is 60～110cm and it's anterior extremity was encasemented with a balloon. The diameter after aerating is 0.6～2.2cm. There were two gabs in the proximal end, the one lead to the balloon with spigot; the other one lead to the conduit without spigot in front of the balloon which was used to pour gas, measure pressure and inject drug. (2) Catheter special for bronchofibroscope (pattern number: Bronch blocker 170, German Ruesch company), tube length 170cm, external diameter 2 mm; anterior extremity was encasemented with a balloon (maximum diameter 2.0 cm). The spigot system could be separated from conduit and had two debouches, the one lead to the anterior extremity of conduit in order to pour drug and localization, the other one with spigot lead to the balloon. (3) Olympus BF-1T60 bronchofibroscope, the working passageway was 2.8 mm. (4) The special conduit for injecting fibrin glue, medical fibrin glue. (5) Electrocardiogram monitor, aiming steel-wire, pressure gage (spinal fluid pressure gauge) and surgical thread .All the patients were divided into two groups randomly: control group (group A) and the study group (group B). Group A (fogarty catheter): 30 patients, fogarty catheter were inserted into the lung along the bronchofibroscope working way and placed the balloon on lobes of lung, segment or deutosegmental bronchus in that rupture exist, filling gas, blocked air current and made the cavitas thoracis negative pressure aspiration continuously. At last, the ruptured bronchus was aligned by observing the gas draining in drainage bottle. Group B (Swan-Ganz catheter): 30 patients, using the surgical thread to fix Swan-Ganz catheter and bronchofibroscope, then inserted into the airway together, placed the balloon on lobes of lung and segmental bronchus that rupture exist. At last, filling gas, blocking airway, pouring gas to the distal end, measuring pressure and align the ruptured bronchus. After ascertaining the ruptured bronchus, the special double-lumen injection catheter for fibrin glue was inserted into the working channel of bronchofibroscope. Fibrin glue A and B were infused into the bronchus distal end slowly. The dosage was proper to block the segmental bronchus completely.Then compare the result of localization, running time, adverse reactions between the two groups, and evaluate the effectiveness of the two methods in blocking the bronchus Results1 There was no statistically significance between the two groups in age, sex and type of the pneumothorax.2 The achievement ratio of localization and sealing Group A: 20 of 30 patients were succeeded in localization. 16 of 20 patients were succeeded in sealing at the first time and 2 were succeeded in sealing at the second time. Group B: 26 of 30 patients were succeeded in localization. 21 of 26 patients were succeeded in sealing at the first time and 3 were succeeded in sealing at the second time. No statistically significance between the two groups (P>0.05).3 The localization result of closed pneumothorax patients, group A: 10 of 20 patients were succeed in localization. Group B: 17 of 21 patients were succeed in localization, the difference of localizing ruptured bronchus between the two groups was statistically significant (P<0.05).4 The average running time and average stay of the two groups4.1The average running time A: 14.3±1.2 min, B: 14.8±1.3 min, and no statistically significance between the two groups (P>0.05).4.2The average stay A: 14.3±2.4 d, group B: 13.8±2.1 d, there was no statistically significance (P>0.05).5 Comparison of the security between the two groups5.1 The variation of vital signThe vital sign and saturation of blood oxygen were monitored respectively in the pre-treatment and post-treatment (two hours after the operation). There was no statistically significance between the two groups in post-treatment (P>0.05); and there is no statistically significance between the two group in pre-treatment (P>0.05); group A: there was statistically significant between the pre-treatment and post-treatment (P<0.05); group B: there was statistically significant between the pre-treatment and post-treatment (P<0.05).5.2 The adverse effectGroup A: chest complaint 1, pneumonia 1 and fever 2 and pulmonary atelectasis 1. Group B: fever 1, pulmonary atelectasis 1.Conclusion1 Through this research, the method that using surgical thread to fix the double-lumen balloon floating catheter and bronchoscope, and further inserted into the airway together, pouring the gas to the airway and measuring pressure to locate the ruptured bronchus was used. And it comes to a new kind of convenient, safe and inexpensive method.2 As to the closed pneumothorax, the method which was using the double-lumen balloon floating catheter and bronchoscope inserted into the airway together is sensitive than the usage of the Fogarty catheter. |
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