4. 再発を繰り返す難治性気胸に対する手術

Re-operation for Recurrent Spontaneous Pneumothorax

人口10万人あたりの自然気胸の年間罹患率は男性が7.4〜18人，女性が1.2〜6人と報告されている1）．初回気胸に対する治療法は，肺虚脱度に応じて経過観察または脱気療法が実施され，肺伸展不良例や5日以上の肺瘻持続例，続発性気胸疑い例，血胸合併例，緊張性気胸例，両側同時気胸例，対側気胸既往例，社会的適応例には初回例であっても手術がすすめられる．

Introduction：The decrease in the postoperative recurrence rate after thoracoscopic bullectomy for spontaneous pneumothorax is an issue that should be tackled even at this moment. We presently make sure to do the reinforcement of the visceral pleura around between the staple line on bullectomy and the common sites of the new-born bullae such as apex, top site of S6, interlobar fissure to prevent postoperative recurrence.

Purpose：We evaluated the latest efficacy of preventing postoperative recurrence by widely covering the staple line and the common sites of the new-born bullae with a polyglycolic acid （PGA） sheet after bullectomy.

Methods：Retrospective analyses were performed for 1,097 patients with spontaneous pneumothorax who received thoracoscopic bullectomy at our hospital between January 2011 and December 2020. The 1-year, 3-years, 5-years postoperative recurrence rates of 229 patients with spontaneous pneumothorax were respectively calculated with the Kaplan-Meier method.

Results：The 1-year, 3-years, 5-years postoperative recurrence rates of spontaneous pneumothorax were 0.9％, 3.6％, 4.0％, respectively.

Conclusions：Combination treatment with bullectomy and wide coverage of the staple line and the common sites of the new-born bullae with the PGA sheet reduced satisfyingly postoperative recurrence rates of spontaneous pneumothorax.