Abstract
From March 1985 to June 1997, 451 patients of spontaneous pneumothorax treated at Kangbuk Samsung Hospital were reviewed retrospectively. Most of the patients were male (male to female ratio, 8.2:1). The mean age of the primary spontaneous pneumothorax (PSP) was 26.8 years, and that of secondary spontaneous pneumothorax(SSP) was 53.1 years. 330 out of 451 patients(73%) were PSP. The causes of the SSP were mostly pulmonary tuberculosis and COPD: 87 patients(72%), and 24 patients(19.2%), respectively. All the patient were treated by one of the following modalities: 1)rest and oxygen therapy in 42 patients, 2) closed thoracostomy in 208 patients, 3) thoracotomy in 156 patients, 4) VATS bullectomy in 45 patients. The mean duration of postoperative chest tube drainage was as following: thoracotomy 8.3 days, VATS bullectomy 4.7 days. For recent 3 consecutive years, VATS bullectomy has become the more frequently applied operative procedure than thoracotomy in the treatment of surgically indicated PSP, from 33% in 1994 to 78% in 1996. With the minimally invasive thoracoscopic surgery being more prevalent, VATS bullectomy will be able to be the 1st choice of treatment not only for the recurrent pneumothoracies but also for the some selected cases of the 1st episode pneumothoracies. To verify this approach as clinically acceptable one in terms of cost-effectiveness, recurrence rate, etc, a large scale of multi-institutional clinical study will be needed in a sooner time.
1985년 3월부터 1997년 6월까지 강북삼성병원 흉부외과에서 치료한 자연기흉451례를 후향적으로 임상분석하였다. 대부분이 남자환자 였으며(8.2:1), 원발성 자연기흉환자의 평균연령은 26.8세, 속발성 자연기흉은 53.1세였다.속발성 자연기흉의 원인으로는 결핵이 87례(73%)로 가장 많았고, 만성 폐쇄성 폐질환이 19.2%, 그외 기관지 천식, 폐암, 진폐증, 폐렴 등이었다. 환자의 치료로는 안정 및 산소요법이 42례, 흉강 삽관술로 치료한것이 208례, 개흉하에 폐기포 절제술이나 폐엽절제술을 시행한경우가 156례, 그리고 45례에서는 비디오 흉강경수술을 시행하였다. 평균술후흉관보유기간은 개흉술이 8.3일, 비디오흉강경 수술의 경우는 4.7일이었고 흉강삽관술로만 치료한경우 평균흉관보유기간은 11.2일이었다. 본원의 경우, 최근 3년동안 비디오 흉강경 수술이 외과적 수술의 적응이 되는 자연기흉의 치료에 개흉술보다 더 흔히 적용되는 술식이 되었다(1994 33%, 1996 78%). 향후 비침습적 수술방법이 더욱더 발전함에 따라 비디오 흉강경 수술은 자연기흉의 일차적인 치료방법이 될 수 있을 것으로 생각되며, 이의 적절성을 평가 하기위한 다자간의 공동연구가 요구된다.