| Purpose:Primary spontaneous pneumothorax(PSP)is a common disease in thoracic surgery,and thespontaneous rupture of subpleural bullae is thought to bethe primary cause of PSP.Currently,video-assisted thoracoscopic(VATS)bullectomyis widely performed as the most common surgical treatment for PSP.However,a prolonged postoperative air leakage is still the most frequent and troublesome early complication after the bullectomy.Thisstudy aimed to explore the efficacy of polyglycolic acid(NEOVEIL)sleeve inpreventing postoperative air leakage after a VATS bullectomy for PSP.Methods:The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in Beijing Chaoyang Hospital,Capital Medical University,and were randomly assigned to the experimental and control groups.All patients underwent a 2-port unilateral VATS bullectomy under general anesthesia with a double-lumen endotracheal tube,and single lung ventilation during the operation.The experimental group applied a Neoveil sleeve combined with an automatic stapler in the bullectomy,while in the control group,the bullae were resected using an automatic stapler alone during the operation.In addition,the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection.Useful clinical data were recorded,including the postoperativetemperature per day,the postoperative volume of drainage,postoperative air leakage time,the drainage tube removal time,the postoperative hospital stay,the postoperative complications,and the postoperative recurrence.Results:A total of 134 patients were enrolled in this study.The experimental group consisted of 60 subjects,and there were 74 in the control group.No operative related mortality was observed in either group.In the experimental group,44 of the 60 patients did not have an air leakage immediately after the operation,while in the control group 40 patients did not have animmediatelyair leakage,which was significantly lower than the experimental group(P=0.031).But,there was no significant difference in the number of patients with a air leakage one day,two days,three days,four days and more than five days between the two groups.Compared with the control group,the average postoperative air leakage(0.57±1.11 days),the chest tube removal time(3.03±0.92 days),and the postoperative hospital stay(3.98±0.92 days)were all significantly shorter in the experimental group(P=0.048,P=0.012,and P=0.010,respectively).There were 5 patients in the experimental group,16 patients in the control group,with a postoperativetemperature higher than 38.5℃(P=0.035).Moreover,the rate of postoperative complications in the experimental group was lower than the control group(3.33% vs.16.22%,P=0.021).No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months.Conclusion:The use of polyglycolic acid sleeve during VATS bullectomysurgery for PSP might effectively prevent early postoperative air leakage,as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.And the procedure is easy to perform without relevant side-effect,so it is very appropriate forthe treatment in patients with PSP. |
