Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (15)
There are also several reports of pleurodesis for the treatment of spontaneous pneumothorax. In particular, the injection of tetracycline into the pleural cavity is considered effective, with few side effects; however, this method results in adherence of one entire lobe of the lung to the chest cavity. Although it is effective in stopping air leakage, there have been no reports concerning problems in pulmonary function which may occur in later life. In other words, when a patient who had been afflicted with pleuritis in youth is afflicted later in life with a disease such as pneumonia or lung cancer that entails dyspnea or requires surgery, we routinely find an exacerbation of symptoms or difficulties in carrying out surgery due to impairment in pulmonary function.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (14)
There are only a few reports in which thoracoscopy using the FB and a rigid thoracoscope are compared. Moreover, most of the reports pertain to the diagnosis of diseases complicated by pleural fluid. To our knowledge, there are no reports comparing SPECT to a FB. Regarding the diagnosis of diseases complicated by pleural fluid, Senno et al recommended the use of the FB to facilitate the discovery of lesions. On the other hand, Oldenburg and Newhouse reported that a rigid thoracoscope is better for accurate biopsies, while Sarkar et al stated that biopsy using a FB is not only possible but superior to a rigid thoracoscope.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (13)
In addition, we thought that the short rigid thoracoscopy mantle made it difficult to hold the FB tip in place, and that its elliptic inner diameter could not be maintained airtight. We used a straight cylindric outer sheath which can be easily inserted in a manner similar to a thoracic cavity drain, and since the sheath is made of metal, the FB can be passed smoothly. In addition, airtightness in the thoracic cavity following insertion of the FB can be maintained to a certain degree. Since the effective length is 21.5 cm, even though 10 cm is inserted into the thoracic cavity, 10 cm still remains outside of the thoracic wall.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (12)
There were 9 out of 31 cases in which we could not find blebs by rigid thoracoscopy; however, there were only 5 cases, which represent only 6 percent of the total patients with spontaneous pneumothorax who were admitted, where blebs did not heal although we were able to find them. Based on these results, we thought it was possible to further reduce the thoracotomy rate by widening the visible area of the thoracoscope to assure that blebs are found. One method of widening the visible area for thoracotomy is to use a flexible thoracoscope, which has been built as a prototype but not yet generally marketed.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (11)
Consequently, the proportion of cases that actually required thoracotomy was apparently about 22 percent when combined with recurrent cases following SPECT. We performed rigid thoracoscopy on almost all cases from 1981 through 1987 without excluding, on the basis of preoperational thoracic cavity radiography, cases that did not heal by conservative therapies. Although our success rate with SPECT was only 17 out of 31 (55 percent), only 13 (16 percent) of the 79 cases ultimately required thoracotomy.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (10)
Spontaneous pneumothorax is a potentially life-threatening condition. Prior to 1978, treatment involved either conservative therapy consisting of rest, needle puncture, or thoracic cavity drainage or a thoracotomy. The development and introduction of new methods of treatment can provide effective alternatives for treating spontaneous pneumothorax.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (9)
In one (case 8) of the two cases with multiple blebs where recurrence occurred at one and three months after treatment, we repeated therapy using high-frequency electrocoagulation. In the other case (case 10), thoracotomy was performed after readmission of the patient. In a total of eight cases that included two cases (cases 12 and 18) of giant blebs (greater than 4 cm diameter) and six cases (cases 13 to 17 and 19) of extensive and multiple blebs, we thought that high-frequency electrocoagulation therapy alone was inadequate therapy.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (8)
The objectives of broadening the visible thoracoscopic area and finding blebs were achieved in all cases, including three cases (cases 3, 13, and 17) in which blebs were found on the vertical septum side and four cases (cases 4, 14, 15 and 19) with pleural adhesions. High-frequency electrocoagulation was performed in 11 of the 19 cases (cases 1 to 11), and improvement and discharge were achieved in 10 of these cases (cases 1 to 10). We had to resort to a thoracotomy in one case (case 11) when the patients condition did not improve. No recurrences have occurred over an observation period of 4 to 26 months (average of 18.7 months) in 7 (cases 1 to 7) out of the 10 patients who improved and were discharged; however, recurrence occurred on the eighth day in one case (case 9) with a bleb in the pulmonary apex area and at one and three months after discharge in two cases (cases 8 and 10) of multiple blebs.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (7)
The results of using the outer sheath and FB method described herein on 19 patients with spontaneous pneumothorax are shown in Table 2 and in the following tabulation, listing numbers of cases (numbers within parentheses are percentages):
Successful high-frequency coagulation 8 (42)
Successful the first time 1
Recurrence after improvement following coagulation; repeat coagulation 1
Healed after fibrinogen and thrombin injection and spray 7 (37)
Recurrence after high-frequency coagulation; fibrinogen and thrombin injected 1
Fibrinogen and thrombin injection into blebs 2
Fibrinogen and thrombin injection and spray 1
After high-frequency coagulation, fibrinogen and thrombin sprayed 2
Fibrinogen and thrombin sprayed 1
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (6)
The outer sheath is usually inserted under local anesthesia into the anterior axillary line between the fourth and fifth intercostal space while the patient is in a lateral position with the unaffected side down in the same manner used for the insertion of a thoracic drain. After removal of the mandrin, a FB is inserted, and the thoracic cavity is observed. The FB passes smoothly through the outer sheath, and since the length of the FB protruding from the tip is freely adjustable, extensive observations are possible, including the posterior surface of the lung, as well as the interlobar surfaces.