Objective
To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae.
Methods
We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated.
Results
The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase.
Conclusion
INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.
ObjectiveTo systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax.
MethodsWe searched PubMed, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI from their inception to December 2nd, 2014, to collect randomized controlled trials (RCTs) of simple closed drainage versus closed drainage combined with pleurodesis in the treatment of spontaneous pneumothorax. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.
ResultsA total of 5 RCTs including 499 patients were included. The results of meta-analysis showed that:Compared with the simple closed drainage, the closed drainage combined with pleurodesis was superior in the effective rate of recurrence spontaneous pneumothorax (OR=6.85, 95%CI 3.26 to 14.39, P<0.000 01) and the recurrence rate of primary spontaneous pneumothorax (OR=0.32, 95%CI 0.18 to 0.57, P<0.001). But there were no statistical differences in both groups in the effective rate of primary spontaneous pneumothorax (OR=1.49, 95%CI 0.71 to 3.14, P=0.29), the hospital stays of primary spontaneous pneumothorax (SMD=0.08, 95%CI -0.16 to 0.31, P=0.52), the hospital stays of recurrence spontaneous pneumothorax (SMD=-1.67, 95%CI -3.96 to 0.61, P=0.15), and the duration of drainage of primary spontaneous pneumothorax (SMD=-0.11, 95%CI 0.79 to 0.58, P=0.76).
ConclusionCurrent evidence suggests that closed drainage combined with pleurodesis could improve the effective rate of recurrence spontaneous pneumothorax and decrease the recurrence rate of primary spontaneous pneumothorax. Due to limited quantity and quality of included studies, the above conclusion should be validated by more high quality studies.
ObjectiveTo evaluate the efficacy, safety, and long-term recurrence rate of thoracoscopic bullae resection combined with parietal pleurectomy or pleural abrasion for the treatment of spontaneous pneumothorax. MethodsRelevant literatures were searched in PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, Wanfang and VIP databases from the establishment of each database to February 1, 2025. According to the inclusion and exclusion criteria, the literatures were screened. Meta-analysis was conducted using Review Manager 5.3 software, and the quality of the literatures was evaluated using the Cochrane Bias Risk Assessment Tool and the NOS scale. ResultsA total of 23 articles were included, including 6 randomized controlled studies and 17 retrospective cohort studies, with NOS scores≥7. A total of 3 296 patients were enrolled, including 1 245 in the parietal pleurectomy group and 2 051 in the pleural abrasion group. The meta-analysis results showed that the pleural abrasion group had shorter operation time [MD=19.68, 95%CI (14.12-25.25)], less intraoperative blood loss [MD=11.31, 95%CI (4.20-18.41)], lower postoperative pain score [MD=0.48, 95%CI (0.04-0.91)], lower total postoperative drainage volume [MD=44.31, 95%CI (11.92-76.71)], shorter postoperative drainage time [MD=0.32, 95%CI (0.03-0.60)], and shorter hospital stay [MD=0.40, 95%CI (0.23-0.57)] compared with the parietal pleurectomy group, and the differences were statistically significant (P<0.05). In terms of safety, the parietal pleurectomy group increased the incidence of postoperative pulmonary hemorrhage [OR=3.99, 95%CI (1.49-10.65), P<0.05], but there were no statistically significant differences in the incidence of postoperative atelectasis, pneumothorax leakage and pulmonary infection (P>0.05). In addition, the parietal pleurectomy group could effectively reduce the long-term recurrence rate of patients [OR=0.48, 95%CI (0.36-0.64)], and the difference was statistically significant (P<0.05). ConclusionDecortication inevitably imposes a greater perioperative burden on patients with spontaneous pneumothorax and pulmonary bullae, yet it effectively reduces the risk of postoperative recurrence. While both surgical approaches exhibit similar safety profiles, parietal pleurectomy may elevate the risk of postoperative pulmonary hemorrhage. Therefore, the optimal treatment strategy should be determined based on individual patient characteristics.
Autologous blood patch pleurodesis (ABPP) was first proposed in 1987. Now it is mainly used to treat intractable pneumothorax and persistent air leakage after pneumonectomy, and also used to treat pneumothorax in children and other rare secondary pneumothorax. Persistent air leakage and pneumothorax of various causes are essentially alveolar pleural fistula. It can usually be treated by closed thoracic drainage, continuous negative pressure suction and surgery. Pleurodesis is a safe and effective alternative to surgery for patients who have failed conventional conservative treatment and can not receive operations. Compared with other pleurodesis adhesives, autologous blood (ABPP) is safer and more effective, and it is simple, painless, cheap and easy to be accepted by patients. But in the domestic and foreign researches in recent years, many details of ABPP treatment have not been standardized. For further research and popularization of ABPP, this article reviews the detailed regulations, efficacy and safety of this technology.
Objective
To investigate the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and pleurodesis for spontaneous pneumothorax.
Methods
A retrospective analysis of 157 patients with spontaneous pneumothorax undergoing VATS from January 2012 to March 2016 in our hospital was done. According to different treatments, patients were divided into two groups: a group A (65 patients receving pleurodesis, 52 males and 13 females with a mean age of 34.77 years ranging from 17 to 73 years) and a group B (92 patients without pleurodesis, 76 males and 16 females with a mean age of 34.66 years ranging from 16 to 72 years). In the group A 29 patients underwent closed thoracic drainage; while in the group B there were 39 patients.
Results
The patients were followed up for 3 months to 4 years. The recurrence rate of the group A was lower than that of the group B, but the difference was not statistically significant. For patients receving closed thoracic drainage preoperatively, intraoperative drainage volume at postoperative 24 h in the group A was more than that of the group B, but postoperative hospital stay was less than that of the group B (P<0.05). For patients not receving closed thoracic drainage preoperatively, drainage volume at postoperative 24 h, total drainage volume, postoperative hospital stay in the group A were more than those of the group B (P<0.05).
Conclusion
Pleurodesis can not reduce the recurrence rate of spontaneous pneumothorax. Preoperative closed thoracic drainage combined with intraoperative pleurodesis can effectively reduce postoperative hospitalization; therefore pleurodesis is recommended. If preoperative closed thoracic drainage is not adopted, surgery without pleurodesis can effectively reduce thoracic drainage at postoperative 24 h, total drainage volume and hospital stay and the perioperative results are better; therefore mechanical pleurodesis is not recommended.
