Clinical significance of dissection of pulmonary ligament for the video assisted thoracic surgery with bullectomy for spontaneous pneumothorax / 中华胸心血管外科杂志

ABSTRACT

Objective To evaluate the clinical significance of dissection of pulmonary ligament was operated on videoassisted thoracic surgery(VATS) with bullectomy for spontaneous pneumothorax.Methods From Jan 2012 to Dec 2013, 232 patients (188 males, 44 females) underwent VATS with bullectomy for spontaneous pneumothorax or hemopeumothorax, whose age were between 14 and 45 years and mean age was(26.4 ± 10.1) years.202 patients resulted from upper lobe spontaneous pneumothorax, 23 patients for lower lobe spontaneous pneumothorax, 7 patients for hemopeumothorax, and 18 cases because of recurrence after bullectomy (7.7 ％, 18/232).all the patients were accepted bullectomy with or without dissection of pulmonary ligament.Results Between 112 patients who underwent upper lobe bullectomy with dissection of pulmonary ligament, at 1 st postoperative day, it was found 92 patients whose pleural effusion were less than 300 ml (82.1％ ,92/112);20 patients whose pleural effusion were greater than or equal to 300 ml(17.9％, 20/112), and the mean drainage from thoracic cavity was(147.0 ± 61.0)ml.At 3 rd day, the mean drainage was(33.4 ± 20.0) ml.Within 23 cases who underwent lower lobe bullectomy with dissection of pulmonary ligament, the mean drainage from thoracic cavity, at 1 st postoperative day, was (155.2 ±41.1)ml,and the mean drainage, at the 3rd day, was(52.1 ± 21.3)ml.Also,within 90 patients who underwent bullectomywithout dissection of pulmonary ligament, 9 patients whose pleural effusion, at 1 st postoperative day, were less than 300ml(10％ ,9/90);81 patients whose pleural effusion were greater than or equal to 300ml (90％, 81/90);the mean drainage for 90 patients was(65.1 ± 28.0)ml.At the 3rd day, 40 patients' pleural effusion were greater than or equal to 300ml (44.4％,40/90) , and the mean drainage was(40.2 ± 25.5) ml.2 of 7 hemopeumothorax patients bled for the vessels injury during pulmonary ligament avulsion.Conclusion There was significant difference in clinical outcomes between two groups, and the dissection of pulmonary ligament was able to reduce the pooling of pleural effusion, facilitate the drainage of pleural effusion, and prevent pneumothorax recurrence, but there is no convincing evidence that dissection of pulmonary ligament can lead to bronchial deformation, stenosis, and reduce the free thoracic space.