ABSTRACT
Background: Tuberculosis is the most common cause of secondary spontaneous pneumothorax (SSP) in India. The prevalence of SSP in patients with pulmonary tuberculosis (PTB) is between 1- 3%. There were only few studies in the literature that specifically analyze tuberculous PNTX. In a study from this hospital, author found PTB was the most common cause of SSP. Now, author aimed at studying the clinical profile of tuberculosis associated PNTX cases and compared with pulmonary tuberculosis cases without PNTX.Methods: This was a single centre prospective observational case control study done at a tertiary care hospital. Fifty patients of tuberculous pneumothorax as cases, and 100 patients of pulmonary tuberculosis without pneumothorax were taken as control. The demographic data, clinical presentation, and radiologic presentation, outcomes after treatment were recorded in both the groups. The data was analyzed using statistical software (SPSS) using appropriate statistical tools.Results: The mean age of patients in the PNTX group was 38.18±14.132, where as in the control group it was 45.29±14.89 (p-value of 0.0052). Past history of tuberculosis was present in 27 (54%) cases of PNTX group and in 41 (41%) cases in the control group (p-value of 0.091). The mean duration of length of hospital stay in PNTX group was 16.5±11.865 days and in non-pneumothorax group was 6.2±2.54 days (p-value was 0.0001).Conclusions: Tuberculous pneumothorax was more common between 30-40 yrs age group. Gender and smoking have no association with PNTX. Tuberculous pneumothorax was more common in previously treated cases of TB. Patients with tuberculous PNTX have prolonged hospital stay and complications resulting in increased morbidity, financial burden and mortality.
ABSTRACT
BACKGROUND: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. METHODS: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. RESULTS: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). CONCLUSION: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.
Subject(s)
Humans , Lung , Lung Injury , Pneumothorax , Retrospective Studies , Rupture , Thoracic Surgery, Video-AssistedABSTRACT
Objective To evaluated clinical effects and effectiveness of dual-port video-assisted thoracic surgery(VATS)for secondary spontaneous pneumothorax.Methods The clinical data of 48 pa-tients with secondary spontaneous pneumothorax who underwent open thoracotomy(n =18)or dual-port VATS(n =30)were reviewed retrospectively.Mean operation time,mean postoperative drainage period and mean postoperative hospital stay between the two groups were compared.Results All surgeries were suc-cessfully performed without reoperation and severe complications.No patient was converted to thoracotomy in the VATS group.There were significant differences in mean operation time [(67.9 ±7.2)min vs (73.3 ±6.4)min],mean postoperative drainage period [(3.2 ±0.9)d vs(5.0 ±1.3)d],and mean postoperative hospital stay [(7.2 ±1.4)d vs(8.7 ±1.5)d]between the dual-port VATS and open thora-cotomy(P <0.05 ).Conclusion Dual-port video-assisted thoracic surgery can reduce postoperative drainage period and postoperative hospital stay and increase satisfaction.It has little influence on upper limb movement and improves postoperative recovery.
ABSTRACT
BACKGROUND: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). METHODS: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1+/-19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. RESULTS: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). CONCLUSION: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.