Objective: To expolre the indications, safety, advantages and disadvantages of performing artificial pneumothorax prior to medical thoracoscopy. Methods: Data of 152 patients undergoing medical thoracoscopy for pleural diseases in the Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2007 to September 2014 were studied through retrospective analysis. According to the performance of artificial pneumothorax prior to medical thoracoscopy, the pleural space adhesions and the pleural effusions, patients were grouped into artificial pneumothorax group (107 cases) and non-artificial pneumothorax group (45 cases), adhesion group (102 cases) and non-adhesion group (50 cases), and few or no pleural effusion group (94 cases) and massive pleural effusion group (58 cases), respectively. The incidence of complications such as subcutaneous emphysema, pleural reaction, infection, aeroembolism and pulmonary injury/hemorrhage in different groups were compared, and the vital signs of patients were observed. Results were compared using the Chi square test. Results: After thoracoscopic examination, the definite diagnosis rates of artificial pneumothorax group and non- artificial pneumothorax group were 83.2% (89/107) and 93.3% (42/45) respectively, which showed no significant difference (χ(2)=2.744, P=0.098). Three cases of subcutaneous emphysema occurred in the artificial pneumothorax group, while all these 3 cases belonged to adhesion group, and one of them belonged to few or no pleural effusion group, and 2 of them belonged to massive pleural effusion group. No subcutaneous emphysema cases were observed in the non-adhesion group. In the non-artificial pneumothorax group, one case of lung trauma caused by trocar was observed, which belonged to adhesion group and few or no pleural effusion group; no lung puncture wound cases were observed in massive pleural effusion group and non-adhesion group. Other complications related to artificial pneumothorax and thoracoscopy, such as pleural reaction, infection, air embolism and pulmonary injury/hemorrhage, were not observed. No significant changes were found between the vital signs of patients before and after artificial pneumothorax. Conclusion: For pleural effusion or pleural disease patients with pleural space adhesion, the performance of artificial pneumothorax prior to operation was recommended. Artificial pneumothorax was not recommended for patients without pleural space adhesions.
目的： 探讨内科胸腔镜术前施行人工气胸的指征、安全性及其利弊分析。 方法： 回顾性分析2007年4月至2014年9月首都医科大学附属北京天坛医院152例因胸膜疾病经内科胸腔镜手术的患者资料,其中男98例，女54例，平均年龄（59±28）岁。根据内科胸腔镜术前是否实施了人工气胸、胸膜腔内是否有粘连以及胸腔积液情况分为人工气胸组（107例）和非人工气胸组（45例），粘连组（102例）和无粘连组（50例），少量或无胸腔积液组（94例）和大量胸腔积液组（58例）。比较各组皮下气肿、胸膜反应、感染、空气栓塞以及肺损伤出血等并发症的发生情况，并观察人工气胸前后患者生命体征的变化。确诊率的比较采用卡方检验。 结果： 内科胸腔镜检查后，人工气胸组与非人工气胸组的确诊率分别为83.2%（89/107）和93.3%（42/45），差异无统计学意义（χ(2)=2.744，P=0.098）。人工气胸组中3例发生皮下气肿，这3例均属于粘连组，其中少量或无胸腔积液组1例，大量胸腔积液组2例，而无粘连组未见皮下气肿病例；非人工气胸组中，胸腔粘连组1例发生套管针导致的肺戳伤，这例患者也是少量或无胸腔积液组，大量胸腔积液组未见肺戳伤病例，而无粘连组没有肺戳伤病例。其他与人工气胸及胸腔镜检查相关的胸膜反应、感染、空气栓塞以及肺损伤出血等并发症均未见。人工气胸前后患者的生命体征亦无明显变化。 结论： 对于有胸膜腔粘连的胸腔积液或胸膜疾病患者，建议常规于术前实施人工气胸。无胸膜腔粘连的患者不建议行人工气胸。.
Keywords: Intraoperative complications; Lung trauma; Pneumothorax, artificial; Thoracoscopy.