Pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax

Primer spontan pnömotoraksın cerrahi tedavisinde plörodezis yöntemleri

Authors

  • Hıdır Esme SBU Konya SUAM

Keywords:

Primary spontaneous pneumothorax, surgery, pleurodesis methods

Abstract

Pneumothorax is the collection of air in the pleural space. Pneumothorax can be spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax mostly occurs in healthy individuals without an apparent cause, probably due to the rupture of subpleural emphysematous bullae located on the apex of the lung. It usually occurs in tall and healthy males younger than 40 years old. Primary spontaneous pneumothorax has a recurrence rate of 20-30% after the first attack, 50% after the second attack, and 80% after the third attack. Surgery is presented as a treatment option to reduce the high recurrence rate after the second attack. It has been reported that recurrence is between 10 and 20% in patients who undergo bullectomy or wedge resection with endoscopic steps alone. Therefore, various pleural pleurodesis methods are applied in addition to bulla resection in order to reduce the recurrence rate after surgery. In mechanical pleurodesis, adhesion between visceral and parietal pleura is achieved by mechanical abrasion of the parietal pleura or by total or partial removal of the parietal pleura. In chemical pleurodesis, the visceral pleura is adhered to the parietal pleura by creating irritation in the pleura with chemical agents. In cases where pleurodesis was added, the recurrence rate was reported to be between 1.7 and 2.8%. Whether the pleurectomy, pleural mechanical or chemical abrasion methods performed with video-assisted thoracoscopic surgery is superior for preventing recurrence is still a matter of debate. In this article, we aimed to discuss the advantages and disadvantages of pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax in the light of the literature.

ÖZET

Pnömotoraks, plevral boşlukta hava toplanmasıdır. Pnömotoraks spontan, travmatik veya iyatrojenik olabilir. Primer spontan pnömotoraks çoğunlukla akciğer apeksinde yer alan subplevral amfizematöz büllerin rüptürüne bağlı olarak ortaya çıkar.  Genellikle 40 yaşından küçük, uzun boylu ve sağlıklı erkek bireylerde ortaya çıkar. Primer spontan pnömotoraks ilk atak sonrası %20-30, ikinci atak sonrası %50, üçüncü atak sonrası %80 nüks oranına sahiptir. İkinci atak sonrası yüksek nüks oranını azaltmak için cerrahi bir tedavi seçeneği olarak sunulmaktadır. Tek başına endoskopik stepler ile büllektomi veya kama rezeksiyon yapılan hastalarda nüksün %10 ile 20 arasında olduğu belirtilmiştir. Bu nedenle cerrahi sonrası nüks oranını azaltmak için çeşitli plevral plörodezis yöntemleri bül rezeksiyonuna ilave olarak uygulanmaktadır. Mekanik plörodeziste, paryetal plevranın mekanik abrazyonu veya paryetal plevranın total veya kısmen çıkarılmasıyla, viseral ve paryetal plevra arasında yapışma sağlanmaktadır. Kimyasal plörodeziste ise kimyasal ajanlarla plevralarda irritasyon oluşturularak visseral plevranın paryetal plevraya yapışması sağlanmaktadır. Plöredezin ilave edildiği olgularda nüks oranının %1.7 ile 2.8 arasında olduğu bildirilmiştir. Video yardımlı torakoskopik cerrahi ile yapılan plörektomi, plevral mekanik veya kimyasal abrazyon yöntemlerinden hangisinin nüksün önlenmesinde üstün olup olmadığı halen tartışma konusudur.

Bu yazıda primer spontan pnömotoraksın cerrahi tedavisinde plörodezis yöntemlerinin avantaj ve dezavantajlarını literatür eşliğinde tartışmayı amaçladık.

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Published

2021-07-07

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