Risk Factors Analysis For Reoperation In Young Patients With Pneumothorax After Closed Thoracic Drainage

Background:Primary spontaneous pneumothorax is a common disease in medical practice,which affects young healthy people and has a high recurrence rate.PSP refers to the air entering the pleural space caused by non-invasive factors or medical intervention,which usually occurs in young people aged 10-30 years old.Its risk factors include male,age and smoking.The typical clinical manifestations begin with acute onset of chest pain and shortness of breath.Chest X-ray can help the diagnosis of the disease.The elimination of intrapleural air and the prevention of future recurrence are the main objectives of treatment.Treatments for the disease include closed thoracic drainage,thoracic puncture,thoracoscopic surgery（VATS）and thoracotomy.Female,low-body weight,smoking and male’s,height Certain radiographic features were all considered risk factors for recurrence.^[1-2]In clinical practice,young PSP patients are usually treated with closed thoracic drainage first,and VATS treatment should be considered if there is persistent air leakage or postoperative recurrence.Purpose:This subject intends to retrospectively analyze and statistics the related-recurrence factors in the clinical data of young patients with PSP who recurrence after closed thoracic drainage and reoperation in our hospital from 2012 to 2018,compared with the control group of young PSP patients without recurrence after closed thoracic drainage,the risk factors were discussed and determined,so as to guide the optimal treatment plan for patients and avoid the pain and economic loss caused by the second surgery after recurrence.This is also the clinical significance of this topic.Method:The research method of this subject is to retrospectively analyze admitted to the General Hospital of Tianjin Medical University from May 2012 to December 2018who met the requirements of the subject,the 40 patients were all patients who could not solve their condition after closed thoracic drainage and underwent closed thoracic drainage again or who had pneumothorax recurrence and underwent video-assisted thoracoscopic pulmonary bullae resection（pleural fixation）,then compare them with40 young patients who were cured after thoracic closed drainage.SPSS21.0 software was used to analyze the possible influencing factors,and the software mainly used single factor analysis and Logistic multifactor analysis.The counting data are statistically analyzed by the chi-square test method,and the measurement data are statistically analyzed by the t-test method in this software.multivariate Logistic analysis was used to process the factors with statistical significance after univariate analysis.when P>0.05,it indicated that this factor was not statistically significant;when P<0.05,it indicated that there was a statistical difference between the data.Result:①Single factor analysis of the data showed:There was no statistical significance in the occurrence of reoperation in young patients with pneumothorax after closed thoracic drainage in gender（χ2=0.157,P=0.692）,smoking history（χ2=2.635,P=0.105）,pneumothorax side（χ2=0.853,P=0.356）,living environment（χ2=0.346,P=0.556）,onset season（χ2=6.356,P=0.096）,neutrophile granulocyte（t=0.150,P=0.881）and macrophages（t=-0.227,P=0.821）,tracheal length/tracheal transverse diameter（t=1.338,P=0.189）between the two groups（P>0.05）.The age of the experimental group was smaller than that of the control group（20.50%vs 23.95,P=0.004）,and the difference was statistically significant.The BMI of the experimental group was smaller than that of the control group（19.115 vs 20.539,P=0.038）,and the difference was statistically significant.The APD/TD ratio of the experimental group was smaller than that of the control group（0.567 vs 0.619,P=0.012）,and the difference was statistically significant.The number of bullae of the experimental group was greater than that of the control group（4.45 vs 3.00,P=0.022）,and the difference was statistically significant.The proportion of imaging abnormality in the experimental group was higher than that in the control group（35.0%vs 15.0%,P=0.039）,The proportion of normal imaging in the experimental group was lower than that in the control group（65.0%vs 85.0%,P=0.039）,and the difference was statistically significant.②Multivariate logistic regression analysis showed:age:P=0.009,Exp（B）=1.177;BMI:P=0.162,Exp（B）=1.204;APD/TD ratio:P=0.000,Exp（B）=2.139;the number of bullae:P=0.006,Exp（B）=0.621;imaging manifestations:P=0.119,Exp（B）=0.315;Conclusion:①Data of patients in the two groups were not statistically analyzed for gender,smoking history,pneumothorax side,difference of living environment,tracheal length/tracheal transverse diameter and onset season.②BMI and imaging abnormalities were risk factors,but not independent risk factors③Age,APD/TD ratio and the number of bullae were the independent risk factors.