Spontaneous pneumothorax is a pathophysiological manifestation caused by the rupture of the visceral pleura without trauma or human factors and the entry of gas into the pleural cavity resulting in pneumothorax. It is often caused by diffuse obstructive pulmonary emphysema, rupture of pulmonary blisters, and cavity penetration of the pleura near the visceral layer. These conditions are prone to pneumothorax: 1, strong cough, increased abdominal pressure; 2, inhalation tract infection caused by local tracheal semi-obstruction, gas can only enter the distal alveoli, and poor discharge, so that the distal alveolar pressure of the obstruction is increased; 3, wheezing continuous state; 4, mechanical ventilation, continuous positive pressure in the trachea, more than the limit of the pressure that the diseased alveoli can withstand; 5, some physical activity when the sudden exertion, sudden change of position, yawning etc. Spontaneous pneumothorax in adolescents is mostly caused by the rupture of pulmonary blisters under the pleura of the apical part of the lung. Most of the pulmonary blisters are divided into two categories: subpleural tiny pulmonary blisters, with a diameter of less than 1
They are often multiple and can occur in the apical part of the lung, at the margins of the interlobular fissures and at the margins of the lower lobe of the lung. These tiny pulmonary blisters are often the result of straining and poor ventilation during the healing of bronchial and pulmonary inflammation and the formation of fibrous tissue scarring. The spontaneous pneumothorax caused by subpleural microscopic pneumothorax is not easily detected on X-ray chest film or during surgery, so it is called “idiopathic pneumothorax”; pulmonary parenchymal pneumothorax is often solitary, mostly occurring in the apical part of the lung, due to congenital hypoplasia of the dirty pleura and the gradual appearance of pulmonary pneumothorax, this kind of spontaneous pneumothorax is commonly found in thin and tall adolescents, during During surgery, the underlying lesions within the lung parenchyma associated with them are often not found, except for the pulmonary blisters. These two types of spontaneous pneumothorax caused by ruptured pulmonary blisters can be triggered by vigorous activity, coughing, sneezing, or can occur in a quiet state. Spontaneous pneumothorax in elderly patients is also called “secondary pneumothorax”, which is mostly caused by long-term lung diseases, such as chronic bronchitis, emphysema, tuberculosis, extensive fibrosis of the lung, etc., resulting in a decrease in the elasticity of the alveolar wall, which leads to the expansion of the alveoli and the production of pulmonary blisters, and then, when the patient coughs or under other conditions, the blisters rupture and a pneumothorax. The typical manifestation of spontaneous pneumothorax is sudden onset of chest pain and shortness of breath, which may be accompanied by coughing. The severity of symptoms is related to the amount of pneumothorax (i.e., the degree of gas compression of lung tissue) and to the presence or absence of concomitant diseases, for example, patients with severe emphysema and poor respiratory function may have significant symptoms even with a smaller pneumothorax and require active management. The most important examination means for spontaneous pneumothorax is X-ray frontal and lateral chest radiographs, which can determine the scope and degree of pneumothorax and the presence of concomitant diseases. The principles of management of spontaneous pneumothorax depend on the degree of pneumothorax, concomitant diseases and whether it is recurrent or not. Generally speaking, for <30% of pneumothorax, needle aspiration or fine catheter aspiration can be performed, while those with more than this degree or with obstructive emphysema, asthma and other diseases, closed chest drainage should be performed. However, some patients do not relieve the pneumothorax after the above treatment, or relapse after remission. For such patients, surgical treatment should be performed to eradicate the problem. The traditional open-chest surgery for wall pleurodesis is also not easily accepted by patients due to the great damage. Television thoracoscopic surgery is becoming more and more popular, which only requires 2-3 small incisions of 1.5-2cm in the chest wall to complete the same operation as open chest surgery.