Applied research thoracoscopic surgery in the treatment for primary spontaneous pneumothorax

Thus for spontaneous pneumothorax, treatment consists of 2 goals: solving gas leaks makes the lungs expand and preventing relapse.In Vietnam since 1995, video assisted thoracic surgery V

Pneumothorax is defined as the appearance of gas in the pleural cavity The most important characteristic of spontaneous pneumothorax in general and primary spontaneous pneumothorax (PSP) in particular are or recurrent The relapse rate of PSP range from 16% to 52% Thus for spontaneous pneumothorax, treatment consists of 2 goals: solving gas leaks makes the lungs expand and preventing relapse.

In Vietnam since 1995, video assisted thoracic surgery (VATS) treatment of pneumothorax was conducted in some hospitals like 103 Hospital, National Lung Hospital, Vietnam-Germany Hospital in Hanoi, Vietnam Czech Hospital in Haiphong Pham Ngoc Thach Hospital, have conducted VATS to treat PSP since 2005 and have used the technique of pleurectomy, pleural abrasion against recurrence There have been many reports on the results of treatment

of spontaneous pneumothorax with VATS is announced but these particular studies on treatment of PSP with VATS no more During surgery, the selection technique is effective and appropriate, choose methods pleural adhesion results, including monitoring of recurrence after surgery has not been paying much attention

Stemming from the practical requirements mentioned above, we question the research aims to:

pneumothorax primary endoscopic surgical thoracic Pham Ngoc Thach Hospital.

New contributions of the thesis

PSP disease common in young people, can rise making and is characterized by relapsing Without treatment interventions to prevent recurrence, the recurrence rate from 16% to average 52% The goal of treatment of pneumothorax is resolved as lung air leaks and prevent further expansion

VATS treatment PSP with pleural adhesion mechanics are effective in preventing relapse with low complication rates, shorter hospital stays, less trauma, low recurrence rate Pleural abrasion for adhedsion in surgery endoscopic thoracic does not cause significant impact on pulmonary function of patients after surgery The size of pneumothorax on radiograph lung can predict the likelihood of air leakage prolong the patient from which the indication of early surgery

Chapter 1: Overview document 31 pages

Chapter 2: Objects and methods of research 24 pages

Chapter 3: Findings 28 pages

Chapter 4: Communicate 28 pages

Conclude; 2 pages and 1npage petition

The thesis includes 40 tables and 9 charts In 111 reference document

13 Vietnamese, 98 English documents

Appendices include studies, references, measuring pain intensity scale, medical research, patient list

CHAPTER 1: OVERVIEW 1.1 Certain anatomical features lung - pleura, pathophysiology, pathology related to PSP

1.2 The clinical features, imaging in PSP

1.2.3 The image of X-ray, computed tomography of pneumothorax

1.2.3.1 Image on chest radiograph

BTS (2010) divided into two categories:

+ Small: when the distance measured on X-ray film from the visceral pleura of the chest to the shore in less than 2cm

+ Large: the distance from the shore in the visceral pleura of the chest over 2cm

1.2.3.2 Image on Film computed tomography chest

CT Scanner is particularly effective in the detection of blebs and bullae

1.3 Treatment of spontaneous pneumothorax primary

1.4 VATS in the treatment of thoracic PSP

1.4.2 Endoscopic surgical treatment of PSP world

1.4.2.2 Identification and management of the lesions

Use endoscopic stapler to cut through the air blebs and bullae advantages: easy to implement, shortening surgery, the rate of air leakage patients after surgery is lower

1.4.2.3 Pleurodesis methods in VATS treatment of PSP

Pleurectomy: Deslauries J (1980) came into the pleurectomy apices

based on the observed peak that most air blebs appear at the top of his lungs.

Pleural abrasion: In 1968, Clagett has suggested using common

methods pleural parietal abrasion into the advantages of safety, less pain, do not affect respiratory function steaming p

1.5 Situation VATST treatment PSP in Vietnam

1.5.1 Surgical treatment situation PSP by VATS in Vietnam

In Vietnam, VATS has been used in the treatment PSP since

1995 in some hospitals such as Vietnam-Germany Hospital, Vietnam-Serbia Hospital, National Lung Hospital, 103 Military Hospital , Cho Ray Hospital, University Hospital of Medicine and recently Trung Vuong Emergency Hospital (HCMC), Pham Ngoc Thach Hospital (HCMC)

1.5.2 Findings treated by VATS PSP chest in Vietnam

There have been many studies of thoracoscopic surgery treatment PSP in Vietnam, mainly focused on clinical characteristics and treatment outcomes of spontaneous pneumothorax general

Chapter 2: SUBJECTS AND METHODS

2.1 Research subjects

Included 118 PSP patients treated with VATS pleural adhesion by mechanical methods in Pham Ngoc Thach hospital from 01/2007 to 08/2013

2.1.2 Criteria selected patients

- Disagnostic PSP

- Treatment by VATS and pleurodesis mechanic

- Age: over 15 years old

- About: both sexes (male and female)

- Agree to participate in research

2.1.3 Exclusion criteria

- Patients PSP treated with other methods

- Disagree to surgery or surgery í contraindicated

- Patients PSP treatment by VATS but pleurodesis by other methods

- Disagree to participate in research, the patient was unable to communicate

- The patients does not have enough information reseach

2.5 The parameters, variables sudied

2.5.1.2 Chest X-ray image

The research criteria: degree of pneumothorax, the number of blebs

2.5.1.3 Image computed tomography chest

The research criteria: size and number of blebs detected

2.5.2 Technique, results PSP primary treatment by endoscopic

thoracic surgery The research targets:

- Results surgery: surgical indications, troca amount, number and

size of blebs (bullae), treatment and leaves the blebs (bullae) and parietal pleural, duration of surgery, intraoperative blood loss, complications surgery, postoperative air leak duration, duration

of postoperative drainage, postoperative drain tube remove, postoperative complications, pain intensity discharge

- Subscribe after surgery (for the group to scratch leaf): The average follow-up period, respiratory function, recurrence.

2.6 Gathering and processing data

The clinical study was standardized and coded variables and advances are collected and processed by Epi Info 7

CHAPTER 3: FINDINGS 3.1 Some clinical features, imaging in PSP

3.1.1 General features

The average age is 28.2 ± 10.2 (16 to 55) Group from 20 - 39, includes 77 trays of entrepreneurs (65.2%) The ratio male / female was 6.4 / 1 77.1% had a BMI <21 The rate of male smokers is 36.3%

3 1.2 Some clinical features

3.1.2.2 History of pneumothorax pleural

Table 3 3: Average length the last time pneumothorax spill from

the time of admission

History of Average length (months)

Patient Mean Sd Shortest Longpicked

Pneumothorax

Comment: Pneumothorax T ran more times, the time between two

times shorter pneumothorax

3.1.2.3 The reason for hospitalization

Chest pain has the rate of 95.8%, chest pain with dyspnea is 60.6%

3.1.3.2 The degree of pneumothorax

Up to 72.9% of patients with pneumothorax high rate Only 24.6%

of patients with localized pneumothorax

3.1.4 Image computed tomography chest

3.1.4.2 The size blebs, bullae

Has 25.7% have bullae> 2 cm, 74.3% have air blebs ≤ 2cm

3.2 Techniques and Results thoracic VATS treatment of PSP 3.2.1 Indications for surgery

There are 83 persons (70.3%) indicated surgery is recurrent pneumothorax No pneumothorax cases of blood spilled

Table 3.15: The relationship between the size of pneumothorax

and indication for surgery

All patients were using 3 troca.

3.3.2.2 Lesions observed in surgery

Table 3:18: Classification of damage according Vanderchueren

Group 1: Not found lesions 02 1.7

Group 2: Thick adhesive pleura 0 0

Group 4: Bullae (> 2cm) 44 37.3

Comment: 61% patients group 3 and 37.3% patients group 4.

Location blebs, bullae

Blebs (bullae) in the upper lobe of right lung have the rate of 56.8% and 43.2% of the left lung

Size blebs (bullae)

There is 62.1% cocoon of air (> 2 cm) and 37,9% air blebs (≤2cm)

Table 3.19: Value detect air blebs (bullae) on computed

tomography

Blebs (bullae) detected by Blebs (bullae) detected Total

Blebs Bullae

N of pts

% N of Pts % N of Pts %

There are air blebs (bullae) 35 54.7 34 87.2 69 67 <0,01

Comment: As gas blebs ≤ 2cm, its rate was 54.7%, and gas bullae>

2 cm detection rate was 87.2%

3.2.2.3 Dealing with injuries

Methods of treatment physical injury

The ball crossed by gas cutting machine stitching takes 61.2%, 10 patients (8.6%) gas ball is crossed by means of clamping sleeve cut and sewn

The treatment leaves a pleural rub.

There were 39 patients using a pleural peel leaf and 79 patients using the pleural leaves scratch

Comment: The average operation time of group peel leaves last

longer than scratch leaves the group (P <0.01)

Table 3.25: The average surgical time management blebs (bullae)

Patient Shortest Longest X±SD Stapler endoscopic

mowers

> 0.05

Comment: The average duration of surgery method by cut and sewn

air balloon is the longest (P> 0.05)

3.2.2.5 Blood loss

Table 3:26: The average amount of blood loss during surgery

Patient At least Most X ± SD Pleurectomy 38 30 2300152.1 ± 362.6 <0,01

Pleural abrasion 37 20 400 78.9 ± 76.4

Comment: Up to 38/39 patients in the group peeled leaf bleeding

which only 37/79 patients heading into the pleural leaves scratch bleeding during surgery (T test, p <0.01)

3.2.3 Subscribe Postoperative

3.2.3.1 Drainage from surgery

Table 3.27: Average Translate drainage after surgery

Right Method Translation pleural drainage (ml p

N of Pts X ± SD At least Most

Pleural abrasion 75 203.7 ± 149.8 50 600

Both groups 111 182, 9 ± 139.2 20 600

Comment: The average fluid drainage after surgery of the pleural

group peeled leaf 1 and day 2 day is less than the pleural leaves scratch in the same time (P <0.01)

3.2.3.2 Air leakage after surgery

There are 98 patients (83.1%) with no air leakage after surgery Only 12.7% of patients with a mechanical block in the group with postoperative leakage The rate of combustion gas blebs and hand-stitched ball is 20% and 40% p> 0.05

Table 3.30: The relationship between 24g postoperative X-ray

images and prolonged air leakage

3.2.3.3 Time drainage after surgery

Table 3:32: The time-averaged drain management methods leaves

Patient Shortest Longest X ± SD

Pleural abrasion 79 1 17 3.1 ± 2.5

Comment: For the group of pleural peel leaves, average lead time is

3.2 ± 3.3 days, during this time, the average time of the group to scratch drainage was 3.1 ± 2.5 days

3.2.3.5 Complications after surgery

Table 3:35: Complications after surgery and treatment methods

Postoperative

Complications

Methods of treatment

Total Wrap

Members leaf

Scratch Members leaf

N of Pts

Comment In the group of pleural peel leaves, the percentage of

patients pleural prolonged air leakage was 2.6% compared with 5%

of patients scratch the pleural leaves There is 7.7% of peel leaves the group with pleural complications hematoma This rate among pleural scratch the leaf is just 1.3%

Table 3:36: The relationship between postoperative complications

and methods of processing the leaves.

Processing

method leaves a

Postoperative Complications

p Air leakage > 5

days

Pleural hematoma

n of Pts

Proportion

%

n of Pts

Comments: The group of the leakage pneumothorax lasting over 5

days has 80% of patients from the group leaves a scratch Complications pleural hematoma has 75% from peel off foil heading into the pleural (p <0.01)

3.2.3.6 The degree of postoperative pain

Table 3:37: The relationship between the level of pain before

discharge and treatment methods leaves a

Comment Only 5.1% of patients in the group to scratch leaves have

a moderate pain and much pain, whereas in the group of pleural peel leaves, the ratio is 51.3% (P <0.01)

32.3.7 Evaluation of surgical con t

There are 82.2% of patients had good postoperative results Of the 8.5% average patient outcomes 3 patients surgical hematoma due to pleural cavity and 3 patients had prolonged air leakage back surgery

3 3.4 Results of monitoring after surgery

3.2.4.1 Time Tracking

In this study, the patients were monitored after surgery, prospective patients with treatment method is to scratch the leaf tobacco into the pleural apex region included 79 patients Time tracking is 31.7 ± 13.9 average month (from 1 to 50 months)

3.24.3 Recurrence after surgery

In 79 patients, prospective follow-up after surgery with 1 case of recurrence of the same party in the first month after surgery

is only treated with oxygen therapy in 5 days In three patients with contralateral recurrence, 2 patients had surgery due to blood spills pleural pneumothorax and pneumothorax recurrence, 1 patient treated at local track

CHAPTER 4: DISCUSSION

4.1 Some clinical features, imaging in PSP.

4.1.1 General characteristics of the patient group studied

4.1.1.1 Age and Gender

The average age of the group is 28.2 ± 10.2 (from 16 to 55 years) The highest age infected men and women from 20 to 39 years old with 65.4% rate for men and 64.7% for women Proportion of patients under 40 was 84.2% for men and 70.6% for women The percentage of patients male / female is 6.4/1 The rate is consistent with the other authors's studies Thus, the most common age of PSP

is in working age with the highest intensity

4.1.1.2 Body mass index (BMI)

In studies on tumors, 78.4% male patients and 68.7% female patients with a BMI <21 Up to 91 patients (78.5%) found blebs in surgery with a BMI <21 Therefore, BMI may be related to the formation of gas blebs or air in the pleural cocoon

4.1.1.3 History of smoking

One of the elements related to PSP is smoking cigarettes Our studies had 36.6% male patients with a history of tobacco smoking youth, 59.5% male patients with a history of smoking relapse The studies by Lang-Lazdunski (2003) also have 43% youth tobacco smoking patients

4.1.2 Some clinical features

4.1.2.1 History of pneumothorax

Our study had 83 patients (70.3%) had a history of pneumothorax while 9 patients (7.6%) had a history of pneumothorax opposite side Among patients with recurrent pneumothorax, pneumothorax rate over 3 is 24.1%

4.1.2.2 History of smoking

One of the elements related to PSP is smoking cigarettes Our studies had 36.6% male patients with a history of tobacco smoking youth, 59.5% male patients with a history of smoking relapse The studies by Lang-Lazdunski (2003) also have 43% youth tobacco smoking patients

4.1.2.3 Location pneumothorax

In our study, pneumothorax the right side represent 56.8% (67 patients), the left side pneumothorax accounted for 43.2% (51 patients) We have not seen any cases of pneumothorax both sides simultaneously This rate is equivalent to the study of other authors

4.1.2.4 Symptoms onset

Pneumothorax usually begins to manifest chest pain and shortness of breath, some patients show signs of coughing In our study, 95.8% of patients with symptoms of chest pain onset, 72.9%

of patients have difficulty breathing manifestation