Surgical management of spontaneous pneumothorax

From 1982 to 1989, 293 patients with spontaneous pneumothorax were treated at VGHTC. There were 251 males and 42 females, aged 1-85 years, mean 49.3 years. The location of pneumothorax included right side 148 cases, left side 129 cases and bilateral 16 cases. The treatment included tube thoracostomy in 282 cases, thoracotomy abrasive pleurodesis in 39 cases, median sternotomy bilateral abrasive pleurodesis in 31 cases and chemical pleurodesis in 18 cases. Indications for pleurodesis included (1) recurrent pneumothorax (2) bilateral pneumothorax (3) persistent air leakage more than 7 days (4) massive air leakage (5) complications of pneumothorax. From our study, we concluded that: (1) The simplest management for spontaneous pneumothorax is tube thoracostomy. (2) In young adults or suspicious bilateral lesions, median sternotomy with bilateral abrasive pleurodesis is first choice of management for some special indications. (3) In aged patients or patients needing concomitant procedure for other pulmonary disease, thoracotomy abrasive pleurodesis is better choice. (4) When poor lung function and contraindicated to have an operation, chemical pleurodesis can also get some advantages.