[Therapeutic strategy for spontaneous pneumothorax]

This study assesed the treatment of spontaneous pneumothorax from April 1998 to October 2004. Chest computed tomography (CT) was conducted on admission to judge the presence or absence of bulla and/or bleb. A total of 168 cases (112 patients) were treated. There were 93 men and 19 women with a mean age of 40.6 (range, 15 to 98) years. Of the total cases, 119 were the first pneumothorax, and 49 cases were recurrence. Video-assisted thoracoscopic surgery (VATS) was the first-choice surgical procedure. We compared a retrospective series of 168 cases treated by observation with chest tube drainage in 94 cases and bed rest in 3 cases (57.7%), VATS in 62 cases (36.9%), or limited thoracotomy (LT) conventionally in 9 cases (5.4%). The recurrence rate by observation, VATS, or LT was 42, 13, and 0%, respectively. The rate of recurrence in the observation group was higher than in the VATS group, and the rate of recurrence in the presence of bulla and/or bleb was 48% and that of recurrence in their absence was 20%. These results suggest that VATS or LT should be recommended for patients with bulla and/or bleb indicated by chest CT. In VATS, an auto-sutured line with a polyglycolic acid (PGA) sheet and the use of fibrin glue spray were thought to be effective in preventing the recurrence of pneumothorax. Futhermore, LT with primary suturing was thought to be useful in cases of skip and multiple, in consideration of the numbers, patterns, and properties of the bulla and/or bleb from the intraoperative findings through the thoracoscope.