What is a spontaneous pneumothorax?
Each of us has 2 lungs in a normal person, called the left and right lung. The lungs are located in the chest cavity and are our vital breathing organs.
The lungs are like a balloon that expands and shrinks as we breathe, week after week. There is a small space between the lungs and the chest wall, medically known as the pleural cavity. Under normal circumstances, the pleural cavity is sealed, contains no gas, is under negative pressure, and contains only a small amount of fluid, which serves as a lubricant.
If air runs into the pleural cavity, it is called a pneumothorax; spontaneous pneumothorax is a category of pneumothorax, which refers to the rupture of a lung without trauma or human factors, causing gas to enter the pleural cavity.
Why does spontaneous pneumothorax occur?
Pneumothorax occurs mainly because of the presence of large pulmonary alveoli on the surface of the lung tissue, ranging in number from one to many. The alveoli look like small blown-up balloons with very thin walls, so they can easily rupture. Once ruptured, gas will enter the chest cavity and pneumothorax will occur.
What body type is prone to spontaneous pneumothorax?
Patients who are thin and tall with flat chest are prone to spontaneous pneumothorax. The possible reason for this is that the negative pressure in the pleural cavity at the tip of the lung is relatively high, which makes it easier to form large alveoli in the long term and, therefore, to develop a spontaneous pneumothorax.
What are the symptoms of spontaneous pneumothorax?
The symptoms of spontaneous pneumothorax are mainly as follows
1, chest pain: is the typical performance of spontaneous pneumothorax, often sudden onset, at first the chest pain is more intense, after a few hours, it will gradually reduce, about 24-72 hours later, the pain gradually disappears.
2, dyspnea: is another typical manifestation, dyspnea often appears in patients with more serious lung air leakage, and the lung is often compressed by > 30%. This is because after the occurrence of pneumothorax, the normal lung tissue is compressed by the gas and becomes smaller, and the respiratory function decreases causing the lack of oxygen. The degree of dyspnea is also related to the lung function reserve, that is, at the same degree of lung compression, generally, the symptoms of chest tightness are lighter in young people than in older people.
3.About 20% of patients with spontaneous pneumothorax may develop pleural effusion. Among them, a few patients are spontaneous hemopneumothorax: as pneumothorax occurs so that the lung suddenly atrophies, tearing off the adhesion bundle and blood vessels, leading to bleeding, which can lead to hemorrhage and shock in serious cases, endangering life and necessitating emergency surgery.
Is spontaneous pneumothorax easy to recur?
Spontaneous pneumothorax is prone to recurrence. According to statistics, the possibility of recurrence of spontaneous pneumothorax within 2 years is 30-50%, and the chance of recurrence after the second attack is 50%; the third is 62%; and the fourth is 80%. In contrast, the chance of pneumothorax recurrence after thoracoscopic treatment is less than 3%.
Is there a trigger for any spontaneous pneumothorax attack?
There is no specific trigger for a spontaneous pneumothorax attack: more than 80% of patients are at rest or in a state of daily life when a spontaneous pneumothorax attack occurs, and only about 9% of patients are in an exercise state.
What is the treatment of choice for spontaneous pneumothorax with pulmonary alveoli?
The traditional methods for treating spontaneous pneumothorax include thoracentesis and closed chest drainage, but both of these methods only promote the discharge of gas from the chest cavity and relieve the symptoms, but do not address the cause of pneumothorax – large alveoli, so they cannot reduce the chance of recurrence of pneumothorax.
Thoracoscopic suturing or resection of large pulmonary alveoli is the preferred method for treating spontaneous pneumothorax. We began using thoracoscopy in 2003 to treat large alveoli as well as spontaneous pneumothorax, and also utilize the suture approach, which makes the procedure much less expensive with the same efficacy.
Advantages of thoracoscopic treatment.
1.Small trauma and light pain, with a total of 3 incisions, located in the axilla, each of which is only 2 cm, with small scars.
2.Fast recovery after surgery, generally able to move on the ground on the second day after surgery, and can be removed 3-4 days after surgery.
3.The efficacy is precise and the possibility of pneumothorax recurrence after surgery is small.
Which patients with spontaneous pneumothorax are suitable for thoracoscopic treatment?
1.Spontaneous pneumothorax with recurrent attacks for more than 2 times; or persistent air leakage even after closed chest drainage
2.Young patients with spontaneous pneumothorax, especially students, who should also have surgery for the first pneumothorax attack due to further education, sports activities, etc., which can reduce the psychological burden
3.Patients with special occupations such as remote areas, working at height, fishermen, drivers, etc. should also have surgery for the first pneumothorax attack because of the greater danger once it occurs.
4, patients with large pulmonary alveoli on both sides, once bilateral pneumothorax occurs at the same time, which may be life-threatening, should also be operated, either at the same time or in stages
5, huge alveoli, due to compression of the surrounding normal lung tissue, even if the pneumothorax does not occur, it will greatly affect the lung function, should also be operated as soon as possible.
How is thoracoscopic surgery for spontaneous pneumothorax and large pulmonary alveoli done?
First, the anesthesiologist administers general anesthesia to the patient, then the patient is placed in a lateral position and ventilated through a double-lumen tracheal tube with a single lung, which, in layman’s terms, means that the diseased side of the lung is artificially left unventilated and atrophied to facilitate the exposure and operation of the surgical field.
After the surgical site is disinfected and surgical towels are laid, the surgeon makes three incisions in the chest wall, averaging about 2 cm each, distributed in a triangle. The lowermost of these incisions is placed into a thoracoscope, which magnifies and transmits the situation inside the chest cavity to a monitor. The surgeon observes the monitor and enters the thoracic cavity through the other two incisions with special thoracoscopic instruments to perform the operation. The surgical operation focuses on finding the large blister and removing it with silk sutures or with a cutting suture.