Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: Consensus and Controversies

胸腔鏡手術治療原發型自發性氣胸之共識與爭議

10.29833/FJS.200810.0002

陳晉興(Jin-Shing Chen)

pneumothorax ； thoracoscopic surgery

Formosan Journal of Surgery

41卷5期（2008 / 10 / 01）

197 - 202

英文

原發型自發性氣胸常發生於瘦高之年輕男性。其引發之病因到目前爲止仍不清楚。原發型自發性氣胸的病程不易預期，使用不同治療方式時，其氣胸復發機率也大不相同。至目前爲止，其最佳治療方式仍無共識。一般而言，對於第一次發作之病患，通常建議選擇較保守的方式（如觀察、細針抽除空氣、或放置胸管等）作爲第一線治療。外科手術雖然可以大幅降低氣胸復發之機率，但因具侵入性，通常使用於復發或第一線治療失敗之病患。最近由於影像輔助胸腔鏡手術之進展，使得原發型自發性氣胸不論在手術適應症、手術方法、及肋膜沾粘方式都有大幅改變。由於胸腔鏡手術具有減輕疼痛、加速復原、及傷口美觀等優點，有越來越多的醫師選擇它作爲治療原發型自發性氣胸之首選。在本論文中，我們將整理文獻，針對原發型自發性氣胸治療之共識與爭議，以及胸腔鏡手術扮演之角色，加以分析討論。

Primary spontaneous pneumothorax (PSP) most commonly occurs in young, tall, lean males. The underlying pathophysiology of this benign disease is poorly understood. The course of PSP remains unpredictable and a wide range of recurrence rates has been noted for different therapeutic approaches. Currently, there is no good consensus on the optimal treatment of PSP. Generally, conservative management (observation, needle aspiration, or chest tube drainage) is recommended as the initial management for the first episode. Surgical intervention is effective in preventing recurrence, but usually reserved for patients with complications or recurrences of PSP. With the development and advances in videoassisted thoracoscopic surgery (VATS), the indications, surgical approaches, and methods of pleurodesis for surgical intervention for PSP have evolved dramatically in recent years. More and more surgeons select nowadays VATS as the preferred approach because of less postoperation pain, prompt recovery, and better cosmetic results. In this review, the consensus is presented and controversies of PSP management are discussed, especially on the roles of VATS.