1 spontaneous pneumothorax including primary pneumothorax and secondary pneumothorax, primary pneumothorax are lung diseases, surgical cases
1 spontaneous pneumothorax including primary pneumothorax and secondary pneumothorax, primary pneumothorax are lung diseases, surgical cases exist in about 90% of subpleural alveoli (subpleural blebs) and pulmonary bullae (bullae), positive results which in some cases can have CT or chest.
2 the diagnosis of spontaneous pneumothorax depends on symptoms, signs and X-ray examination. A plain chest radiograph can be used to determine the extent of lung compression. Chest CT can find some chest X-ray can not find occult pneumothorax, and better evaluation of the lungs.
3 treatment of spontaneous pneumothorax
3.1 simple observation for a small amount of asymptomatic pneumothorax (< < 20%), can be observed, only oxygen is conducive to the absorption of pneumothorax.
3.2 pleural effusion in 2003, the British Thoracic Society (BTS) recommended pleural puncture as first-line treatment of primary pneumothorax, but may have little effect on secondary pneumothorax simple chest. For those with obvious symptoms of secondary pneumothorax, age 50 years old, pleural puncture is not suitable.
3.3 closed thoracic drainage if pleural puncture cannot significantly reduce lung compression and installation symptoms should be promptly closed thoracic drainage; with obvious symptoms and lung compression over 20% secondary pneumothorax preferred closed thoracic drainage. 48 hours later there is still not leak or lung reexpansion, with suction pressure in -12 ~ -20 cm H2O. The use of a closed thoracic drainage tube in the treatment of chemical pleural fixation is mainly used for patients who can not accept or do not want to be treated.
3.4 surgical treatment
3.4.1 is the first choice for early intervention (3-5 days) in patients with persistent pulmonary and pulmonary atelectasis.
Indication of 3.4.2 first stage operation:
Recurrent ipsilateral pneumothorax;
First episode of contralateral pneumothorax
Bilateral spontaneous pneumothorax
The spontaneous hematopneumothorax
The special occupation: divers, pilots, long-term field work
3.4.3 surgery Objective: pulmonary bullae of lung and pulmonary laceration; promote pleural adhesion
The choice of surgical methods of 3.4.4: the choice of surgical treatment for pneumothorax includes total thoracoscopic surgery, video-assisted thoracoscopic surgery, small incision thoracotomy and traditional thoracotomy. Due to the development of minimally invasive surgical techniques and surgical instruments, thoracoscopic surgery can treat more than 80% of the pneumothorax and part of hematopneumothorax.
The main ways of promoting pleural adhesion by 3.4.5 include: pleural exfoliation, physical inflammation caused by pleural friction, and various chemical reactions. Pleural stripping effect is the most accurate, but due to trauma, bleeding, and less application.
4 treatment of complications of spontaneous pneumothorax complications including tension pneumothorax, mediastinal emphysema and hemothorax. Tension pneumothorax is one of the most serious complications of life. The main principle is to relieve the pressure of thoracic cavity immediately. Pneumomediastinum influence circulation, should first mediastinal decompression, then closed drainage.
5 discharge and follow-up
For the simple observation of patients, 2 weeks after the hospital to review the stability of patients with chest treatment should be discharged after 24-48 hours of stable condition;
Most patients should avoid flying within 6 weeks; diving is an absolute contraindication before radical surgery.