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.
Therefore, initially or following high-frequency electrocoagulation, we injected 1 ml of a fibrinogen solution and 1 ml of a thrombin solution into the blebs or sprayed 5 to 10 ml of each solution onto the surface of the blebs. In seven out of eight cases, improvement and discharge followed, while in the remaining case, thoracotomy was required. In 1 out of the 7 patients who improved and were discharged, but recurrence occurred 1 month later, thoracotomy was performed; however, in the remaining six cases, no recurrence has occurred after 3 to 14 months (average of 8.7 months). The frequency of thoracotomy during this period was 4 out of 39 cases (10 percent), which is a marked decrease from the period when we were using a rigid thoracoscope.