Bleb Electrocoagulation Therapy Using a Rigid Thoracoscope
Materials and Methods
Between January 1981 and December 1987, a total of 31 out of 79 patients with spontaneous pneumothorax were treated using a rigid thoracoscopic procedure. Twenty-five patients were selected on the basis of a lack of improvement or the inability to discharge the patient after one to three weeks of treatment involving rest and thoracic cavity drainage. In addition, six patients were selected on the basis of recurrence and readmission after improvement and discharge following thoracic cavity drainage, etc. A rigid thoracoscope (Machida THR-SL-A) was inserted under local anesthesia into the anterior axillary line between the fourth and fifth intercostal space of the thoracic cavity to identify blebs. When blebs were found, we performed high-frequency bleb electrocoagulation.
The cure rates by therapeutic modality for all 79 patients with spontaneous pneumothorax are shown in Table 1. In summary, healing occurred in 43 cases (54 percent) treated by conventional therapy, four cases (5 percent) treated by pleurodesis, and 14 cases (18 percent) treated by thoracoscopic therapy. Thoracoscopic therapy was effective in 17 (55 percent) of 31 cases where conservative therapy had been ineffective.
Table 1—Results in 79 of 95 Patients with Spontaneous Pneumothorax Treated during Seven-Year Period (1981-1987)
|Data||Rest or Needle Puncture||ThoracicDrainage||RigidThoracoscope||Pleurodesis||Thoracotomy||Total|
|Improved and discharged cases (A)||13 (1)||48(6)||17(2)||4 (1)||13 (6)||95 (16)|
|Recurrence (B)||7(0)||11 (1)||3(0)||0||0||21 (l)t|
|Recurrence rate, percent (B/A)||54||23||18||22|
|Healed (A-B)||6 (1)||37 (5)||14 (2)||4 (1)||13(6)||74 (15)t|
|Therapy-specific cure rate, percent ([A-BJ/79)||8||47||18||5||16||94t|