Spontaneous Pneumothorax – Management, Therapy

Czech version

Authors: R. Hrivnák; I. Hanke; P. Šándor ^*; L. Mitáš; J. Vomela
Authors‘ workplace: Chirurgická klinika FN Brno-Bohunice, Lékařská Fakulta Masarykovy Univerzity v Brně, přednosta prof. MUDr. Z. Kala, CSc. ; Chirurgická klinika FN Brno-Bohunice, Lékařská Fakulta Masarykovy Univerzity v Brně, přednosta Klinika nemocí plicních a tuberkulózy FN Brno, Lékařská fakulta Masarykovy Univerzity v Brně, přednostka: Chirurgická klinika FN Brno-Bohunice, Lékařská Fakulta ^*
Published in: Rozhl. Chir., 2009, roč. 88, č. 10, s. 559-562.
Category: Monothematic special - Original

Overview

Objective:
Spontaneous pneumothorax (SPNO) is a surgical disease, which belongs to surgical emergencies. It is divided into a primary, secundary, katamenial and neonatal. A young and healthy men are affected by primary SPNO, usually on the right side of the thorax, recurrence is common. A secondary SPNO typically occurs in patients between the 5th and 7th decenium. These patients usually suffer from some lung disease. A major complications are more common in this type of pneumothorax.

Methods:
At Department of surgery, University Hospital Brno, 73 patients were treated for spontaneous pneumothorax from the January, 2006 till August, 2008. We divided patients in two groups. The first one with primary SPNO, and the second one with secondary SPNO. Hospital stay, age distribution, type of operation, duration of drainage, postoperative complication, histological findings and laterality were followed up retrospectively.

Results:
In group of primary SPNO, 24 patients were operated without major complication. The most frequent cause was bullate emphysema, hospital stay was 8 days, duration of drainage 6 days. The second group with secondary SPNO, five patients were operated, hospital stay was 16.5 days, duration of drainage 10 days. Haemothorax as a postoperative complication occured in one case. In both groups we proved the bullate emphysema as the most frequent cause, as well as a right – sided involvement.

Conclusion:
Spontaneous pneumothorax is a surgical disease. It’s treatment has to be provided by surgeon, if possible by a thoracic specialist. The first occurrence of spontaneous pneumothorax is treated by drainage, the recurrence by operation. The principal is to combine an atypical resection of affected lung with a mechanical pleurodesis. Postoperative complications are not frequent.

Key words:
spontaneous pneumothorax – treatment - management

Sources

1. Paerson, F. G., Cooper, J. D., Deslauriers, J., Glinsberg, R. J., Hiebert, C. A., Patterson, G. A., Urschel, H. C. jr. Thoracic surgery. Second Edition. Philadephia, Churchill Livingstone, 2002, 1942 s.

2. Rindoš, R., Hamžík, J., Láska, M., Vrastyák, J. Spontánny pneumotorax – súčasný pohľad na liečbu. Rozhl. Chir., 1994; 73(7): 334–335.

3. Tierney, L. M. jr., McPhee, S. J., Papadakis, M. A., Schroeder, S. A. Diagnosa a léčba. Praha, Alberta, 1995, 1275 s.

4. Gupta, D., Hansell, A., Nichols, T., Duong, T., Ayres, J. G., Strachan, D. Epidemiology of pneumothorax in England. Thorax, 2000; 55(8): 666–671.

5. Travis, W. D., Colby, T. V., Koss, M. N., Rosado-de-Christenson, M. L., Müller, N. L., King, T. E. jr. Non-Neoplastic Disordes of the Lower Respiratory Tract. In: Atlas of Nontumor Pathology. Washington DC, American Registry of Pathology and the Armed Forces Institute of Patology, 2002, 939 s.

6. Čapov. I. Videoasistovaná torakoskopie a její význam v léčbě spontánního pneumotoraxu. Habilitační práce. Brno, Masarykova universita, 1998.

7. Kresmer, P. Pneumotorax in the newborn. Neonatal Netw. 2000; 19:(4): 57, 62,3.

8. Vodička, J., a kol. Spontánní pneumotorax – etiopatogeneze, diagnostika, terapie, 2007.

9. Vodička, J., Špidlen, V., Ferda, J., Mukenšnabl, P., Šafránek, J., Šimánek, V. Elektivní videotorakoskopie jako prevence vzniku primárního spontánního pneumotoraxu – ano či ne? Rozhl. Chir., 2008, roč. 87, č. 5, s. 228–232.

10. Stolz, A. J., Šimonek, J., Pafko, P. Variace léčby primárního spontánního pneumotoraxu. Rozhl. Chir., 2008, roč. 87, č. 1, s. 5–9.

11. Yasufuku, K., Oiwa, T., Fujisawa, T. The effectiveness of the thin-section computed tomography in diagnosing bullous lesions in patients with spontaneous pneumothorax. Nihon Kokyuki Gakkai Zasshi, 1999; 37(12): 953–957.

12. Schützner, J., Pafko, P. Prvních 300 videotorakoskopických (VTS) a videoasistovaných (VATS) operací. Rozhl. Chir., 1996; 75(5): 255–259.