Are There Any News in the Management of Spontaneous Pneumothorax?

Česká verzia

Authors: J. Vodička
Authors place of work: Chirurgická klinika LF UK a FN v Plzni, přednosta: prof. MUDr. Vladislav Třeška, DrSc.
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 11, s. 625-630.
Category: Monothematic special - Original

Summary

Although numerous medical associations publish various guidance recommendations in order to introduce common procedures and rules for the management of spontaneous pneumotorax (SPNO), no general consensus has been reached in this area. The major controversy remains in the treatment of the 1^st episode of primary SPNO (PSPNO), there is a strong disagreement between advocates of a single, one-step aspiration method and advocates of pleural cavity drainage. Furthermore, some authors promote miniinvasive surgical revision. On the other hand, there is a relative concesus regarding the management of PSPNO relapses, i.e. indication for videothoracoscopic procedure, if feasible considering the patient’s condition. Similarly, there is an agreement concerning individual indications for videothoracoscopy in PSPNO. There is a tendency to prefer least injuring of the organism, resulting in procedures which use a single incision, so called uniportal procedures, and in the use of thoracoscopes and instruments measuring from 2 mm to the maximum of 5 mm in a diameter in so called needlescopic videothoracoscopies. The videothoracoscopic procedure itself, as a standard, includes lung surgery – i.e. removal of the pathology causing pneumothorax, and preventive procedure on parietal pleura, and recently on visceral pleura, as well. Endostapler non-anatomical resection is the commonest lung procedure, while pleuroabrasion or its combination with partial apical pleurectomy are the commonest pleurodesis procedures. Talc pleurodesis features certain comeback after some time. Recently, some authors have turned their attention to, so called, tenting- i.e. strengthening of the endangered visceral pleura parts with absorbable polymers to prevent development of new subpleural blisters or emphysema bulae responsible for the disease recurrence. Drainage of the pleural cavity is the method of choice in the management of the first episode of the secondary SPNO (SSPNO). SSPNO relapses and complications are managed by surgical intervention and, contrary to that in PSPNO, with higher rates of thoracotomy procedures compared to VTS procedures, which is due to inability of these patients to undergo unilateral lung respiration. When this intervention is not feasible, chemical pleurodesis with introduction of a drain using talc, autologous blood or tetracycline derivates is performed. Catamenial pneumotorax with high relaps rates requires videothoracic revision already at its first occurence, accompanied by the causative factor removal, pleurodesis and induction of hormonal amenorrhea.

Key words:
spontaneuos pneumotorax – drainage – pleurodesis – videothoracoscopy

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