Pneumothorax is a common disease in thoracic surgery, which simply means the accumulation of air in the pleural cavity, occupying the position of the lung and compressing it so that it cannot work normally, manifesting as chest pain and chest suffocation, severe respiratory distress, and about 2% of fatal pneumothorax, which should not be underestimated.
In addition to trauma, primary spontaneous pneumothorax and secondary pneumothorax are clinically common. The former is mostly in young people, there is no underlying disease in the lungs, but there are some anatomical abnormalities called pulmonary big butcher lung small butcher-like, mostly congenital development, as if there are some thin-walled small balloons on the surface of the lungs, easy to break and leak air. The latter is mostly seen in the elderly, the lungs exist bronchitis emphysema and other underlying diseases, secondary to the rupture of the lung big booster air leakage.
I. Treatment
1, the first attack, such as more gas leakage, heavy symptoms, more need to place closed drainage of the chest cavity to drain the leaking gas to reduce its compression of the lung. About 70% of the clinical cases can be treated well this time, i.e., no gas leakage and satisfactory lung reopening, and about 30% of the cases are referred to surgery for persistent gas leakage and unsatisfactory lung reopening. About 25% of the 70% of patients who are well recur at an average of 14 months. The advantage of drainage alone is that it is simple and less expensive, but the disadvantage is that it only drains the gas and leaves the lung lesion untreated, with a high recurrence rate. Surgical treatment is possible to deal with the lesions at the same time, so that the recurrence rate is reduced to less than 3-5%.
2.Recurrence treatment, surgery
Surgical method: The traditional way is open-chest surgery, which is a typical small surgery with large incision.
Now the way: thoracoscopic minimally invasive surgery, the efficacy is equivalent to traditional surgery, but with the outstanding advantages of small trauma (only three 1. 5cm incisions are needed to complete the surgery), light pain, little functional impact, and fast recovery (discharged from hospital in 5 days on average after surgery), which is the best choice for treating pneumothorax.
3.For special occupations, such as soldiers, frequent travelers, and some people who are facing the entrance examination immediately, the first attack requires surgery to reduce the impact of pneumothorax recurrence in special moments.
4.Because of the emergence of thoracoscopy, some people also choose direct thoracoscopic surgery because of the fear of recurrence.
Second, the indications for surgery of spontaneous pneumothorax
1.First time pneumothorax but found to be combined with clear pulmonary big booster.
2.The first attack is tension pneumothorax (obvious lung compression, obvious mediastinal displacement, and obvious vital sign changes).
3.At least one side of bilateral pneumothorax is done.
4.Pneumothorax that still leaks air after more than 3 days of closed drainage.
5.Spontaneous hemopneumothorax.
6.Special occupations: such as soldiers, athletes, frequent travelers, pilots, divers, etc.
7.Recurrent pneumothorax (i.e. the second occurrence on the same side).
8.The first pneumothorax after total pneumonectomy (healthy side).
9, the first attack, but the orthopantomogram shows that there are adhesions in the apex of the chest (adhesions in the apex of the chest often have blood vessels in the adhesion bundle that are easy to cause potential bleeding; in addition, the lung is not easy to reopen).
Surgery is now mainly based on thoracoscopic surgery.