Surgical strategies for severe spontaneous pneumothorax

[Objective] To Sum up the methods and effects of surgical strategies for spontaneous pneumothorax.[Methods] 48 case with spontaneous pneumothorax, who were treated by thoracotomy from 1995 to 2005, were retrospectively summarized from several aspects as follows: clinic features, X-ray features and operation indications of severe spontaneous pneumothorax; and the choice of surgical methods. [Results] In the 48 case of thoracotomy, 14 case had anterior lateral incision, 18 had posterior lateral incision, 10 case had subaxillary incision, 6 case had VATS. The surgery verified that spontaneous pneumothorax was caused by pulmonary bulla in 42 cases (87.5%), by pulmonary tuberculosis in 4 cases (8.3%), by the laceration of adhesion belt in thoracic cavity in 2 cases (4.2%). 14 cases had simple ligation of lung bullae, 20 cases had pulmonary bullous incision and suture, 6 cases had pulmonary wedge resection, 2 cases had lobe resection. One patient died in the early postoperative period. The follow-up period ranged from 1 to 5 years. One patient recurred, one had contralateral pneumothorax, others recovered excellently. The main cause of severe spontaneous pneumothorax is lung bullae. Conventional surgical incision and small incision were compared with VATS, different treatments for lung bullae were analyed. [Conclusion] Active surgical treatment should be applied to diagnosed severe spontaneous pneumothorax without contraindications ,the results of operations are satisfactory. Comparing with routine incision, the subaxillary incision has less trauma, faster recovery, but the indications should be strictly chosen.VATS is better than subaxillary incision and routine incision and should be well recommended. For severe adhesion of thoracic cavity and encapsulation in lung, routine incision is the first choice.