高濃度ブドウ糖溶液の自然気胸術後再発抑制効果

Injection of High Concentration Glucose Solution for Pleural Coating Reduces Postoperative Recurrence of Spontaneous Pneumothorax；A Short-term Retrospective Study

自然気胸（spontaneous pneumothorax：SP）の標準術式は胸腔鏡下手術（video-assisted thoracoscopic surgery：VATS）でのブラ切除である．VATSは低侵襲であり，整容性でも優れるが，従来の開胸手術と比較し術後再発率が高いことが知られている．これまでにさまざまな再発予防策が考案されてきたが，いまだ十分な成績とはいえない状況である．近年，手術困

Background：Video-assisted thoracoscopic surgery （VATS） is the standard treatment for patients with spontaneous pneumothorax （SP）. However, postoperative recurrence is not infrequent even with an absorbable covering sheet used to reinforce the visceral pleura. Recent reports suggest that intraoperative injection of a highly concentrated glucose solution into the thoracic cavity provides effective prophylaxis against postoperative SP recurrence. Since September 2015, we have been injecting 50 ml of 50％ glucose solution intraoperatively for pleural coating （GPC） around an absorbable sheet to prevent postoperative SP recurrence. Methods：We evaluated 340 patients who underwent VATS between February 2011 and June 2017（88 patients：GPC group, 252：non-GPC group）, and we retrospectively analyzed the efficacy of GPC in preventing postoperative SP recurrence.

Results：One year postoperative recurrence rates of GPC and non-GPC groups were 9.0 and 17.9％， respectively. The log-rank test revealed GPC as a significant factor in preventing postoperative recurrence （p＝0.020）. No severe adverse events occurred in either group. Minor postoperative complications, viz., high blood sugar, high volume of chest tube drainage occurred in the GPC group.

Conclusion：Application of GPC is beneficial in reducing postoperative recurrence of SP.