Compare Of The Surgical Ways Of Spontaneous Pneumothorax

Pneumothorax is the most common emergency in thoracic surgery and young people accounting the largest number. Spontaneous pneumothorax occurs more frequently in young men, the male to female ratio was 6:1, in particular, is a lanky man smokers prone. Due to various reasons, so spontaneous pneumothorax is the visceral pleura and the lung ruptured gas from the lung caused by the hole into the pleural cavity. Spontaneous pneumothorax can be divided into primary and secondary categories. The former real normal lung, Caused by pulmonary apical vesicles rupture that are under apex pulmonis, the young prevalent; the latter with lung diseases, on the basis of chronic obstructive pulmonary disease and more, bullous emphysema, tuberculosis, silicosis and other lung diseases, common in the elderly, the majority of patients can be cured by medical treatment. About 20% of patients with persistent or recurrent needed for operation.Pneumothorax severity of the symptoms depends on the speed of pneumothorax occurred, the number of air-intake, and the extent of the lung disease:①main sudden chest pain, radiation. Chest pain occurred in the side of pneumothorax, intensified when cough or deep breathing.②Dyspnea: related to the scope of compression of the lung. Young adults have no prime lung disease, the pulmonary function are well, the side of pulmonary atelectasis less than 20%, without any symptoms; When only 90% of the side pulmonary atelectasis have slight complaint of breathing difficulties. Existing chronic lung diseases, the frail elderly, even only 10% of lung compression, there will be serious breathing difficulties. Some patients will appear for progressive dyspnea.③cough :mostly dry cough, expectorate purulent sputum when complicated with empyema.④shock: tension pneumothorax without emergency measures or delayed. In addition to breathing difficulties, the patient may have the symptoms of cyanosis, profuse sweating, cold limbs, thin and fragile pulse, blood pressure, may soon collapsed, dead.Chest diagnosis are routine examination of pneumothorax. Chest CT scan is a good way to assess pneumothorax, the only drawback is the increase in medical costs.Surgery is a effective method. Traditional methods for the treatment are thoractomy. The use and popularity of video-assisted thoracoscopic techniques promote Minimal invasive surgery in people's mind. VATS are recognized his strengths as minimally invasive treatment of pneumothorax, especially primary spontaneous pneumothorax. While subaxillary small minithoractomy (SAMT) are with the same meaning and cost less, can be regarded as a powerful complement of VATS surgery. Currently, the 1st pneumothorax patients need VATS or not are disputed. We think that the following should be included as surgical indications: (1) recurrent pneumothorax; (2) 3-5 days after suffering from thoracic closed drainage still unable to resume or chest is still a lot of gas extraction; (3) The 1st spontaneous pneumothorax on chest radiography or CT scans of a clear lung bullae; (4) suitable for thoracoscope. The first serious pneumothorax patients even not found a clear CT lung bullae (often a long delayed cured, recurrent or special trades should actively engaged in surgical treatment) .Compared with thoractomy, VATS is easy to be accepted by patients because of not bracing ribs, little chest trauma, less bleeding, and quick recovery. With the increasing maturity of the technology, VATS has become the first choice for spontaneous pneumothorax. To avoid long-term postoperative recurrence, thoroughly exploratory surgery should be done. The use of 30°camera ensure a better exploration vision. Because there may be multiple pulmonary bullae, the exploration should be from each lobe to another, finding a lesion is not satisfied, inject enough water to clerify lung leak site when necessary. Finally, pleural adhesions is also important to prevent leakage or recurrent postoperative.The biggest drawback of VATS is high cost of disposables, in contrast, SAMT can be regarded as a powerful additional surgery, which has the following advantages:①latissimus dorsi front chest muscle injury, little respiratory muscle and nerve damage at its disposal. Little influence on postoperative pulmonary function, oxygenation and little lung complications.②covert incision and beautiful nature, especially in the youth and female patients.③avoid cross-sectional injury of the chest wall muscle, no rib resection, the degree and duration of the pain are less than normal, which help patients with cough and sputum.④do not stretch scapula in the operation, activities of the upper limbs will not be affected, and faster recovery. conducive to early movement and activities of daily living, hospitalization time is shorter. But because of the small incision, the exploratory range is limited, pleurodesis is difficult especially when facing to adhesion in apex pulmonis or facies diaphragmatica. Therefore, SAMT should be used on patients without adhesion.We collected clinical data of 236 patients with spontaneous pneumothorax from January 1997 to March 2007, bring in a retrospective analysis of mean incision length, drainage time and volume, postoperative hospital stay in order to analyze the characteristics of the three surgical treatments of spontaneous pneumothorax. In three groups, the HT group has significant differences of all the factors between the two groups have. The average age of traditional thoracotomy is higher, and in some cases makes more complex conditions. Some cases of VATS and SAMT turn to thoractomy, as well as the results of the important reasons for this. After preclude the age difference, there are still significant differences in mean incision length, volume and postoperative hospital stay between other two groups, which demonstration that shortcomings of traditional surgery are caused by itself.In short, the three have exact efficacy on surgical treatment of pneumothorax. VATS represents the orientation of minimally invasion, which is suitable for most pneumothorax cases but expensive, require special training and the difficult to promote in grass-roots hospitals; SAMT is simple, convenient, do not need special equipment, low-cost, no significant difference compared with VATS in postoperative efficacy and complications. SAMT can be the first choice when economic is restricted. If expanded supplemented thoracoscopic surgical field, it can make up for its deficiencies; Traditional thoracotomy plays an irreplaceable role, such as in minimally invasive thoracic surgery conversion to thoracotomy, serious adhesions cases, diffuse bullous cases, some options of secondary spontaneous pneumothorax, can significantly reduce the recurrence rate. Traditional thoractomy is a reserve forces for complex and minimal invasive cases.