자연기흉에서 고해상 전산화단층촬영술과 2 mm 비디오 흉강경검사의 비교 연구

Comparative Study of 2 mm Video-thoracoscopic Examination and High-resolution Computed Tomography for Spontaneous Pneumothoarx Patients

  • 이송암 (건국대학교 의과대학 흉부외과학교실) ;
  • 지현근 (건국대학교 의과대학 흉부외과학교실) ;
  • 황재준 (건국대학교 의과대학 흉부외과학교실) ;
  • 조성준 (강원대학교 의과대학 흉부외과학교실) ;
  • 이성호 (고려대학교 의과대학 안암병원 흉부외과학교실) ;
  • 김광택 (고려대학교 의과대학 안암병원 흉부외과학교실)
  • Lee, Song-Am (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Konkuk University) ;
  • Chee, Hyun-Keun (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Konkuk University) ;
  • Hwang, Jae-Joon (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Konkuk University) ;
  • Cho, Seong-Joon (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kangwon National University) ;
  • Lee, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Anam Hospital, College of Medicine, Korea University) ;
  • Kim, Kwang-Taik (Department of Thoracic and Cardiovascular Surgery, Anam Hospital, College of Medicine, Korea University)
  • 발행 : 2007.05.05

초록

배경: 자연기흉 환자에 있어서 폐기포가 존재할 경우 수술의 적응증이며, 폐기포 진단을 위한 많은 객관적 검사방법이 사용되어져 왔다. 본 연구는 자연기흉에 대해 기존의 고해상 전산화단층촬영술과 2 mm 비디오 흉강경검사의 진단 정확도를 비교 분석하였다. 대상 및 방법: 2001년 6월부터 2002년 3월까지 자연기흉으로 입원한 환자 중 고해상 전산화단층촬영술과 2 mm 비디오 흉강경검사를 모두 시행한 34명의 환자를 대상으로 하였다. 폐기포의 크기가 5 mm 이상인 경우를 의미 있는 폐기포로 간주하였다. 2 mm 비디오 흉강경검사상 의미 있는 폐기포가 발견된 18예와 출혈이 관찰되었던 1예에서 흉강경하 쐐기절제술을 시행하였으며, 나머지 15예는 폐쇄식 흉강삽관술만으로 치료를 하였다. 결과: 2 mm 비디오 흉강경검사상 52.9% (18/34)에서 의미 있는 폐기포가 관찰되었다. 수술을 시행한 19명의 환자에서 2 mm 비디오 흉강경검사의 진단 정확도는 94.7% (18/19)로 고해상 전산화단층촬영술의 13.7% (14/19)보다 높았다. 평균 $30{\pm}3$개월의 추적관찰 기간 중 수술군과 비수술군에서 재발은 없었다. 걸론 국소마취하에 시행하는 2 mm 비디오 흉강경검사는 기존에 사용되던 고해상 전산화단층촬영술보다 진단 정확도가 높으며, 자연기흉 환자에 대한 수술여부를 결정하는 데 유용한 대안적 검사법이라 생각된다.

Background: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. Material and Method: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax undewent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a blob larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant blob via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. Result: Multiple or single blob lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and blob was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of $30{\pm}3$ months, no recurrence occurred in both the operative group and the non-operative group. Conclusion: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.

키워드

참고문헌

  1. Getz SB Jr, Beasley WE. Spontaneous pneumothorax. Am J Surg 1983;145:823-7 https://doi.org/10.1016/0002-9610(83)90151-4
  2. Warner BW, Bailey WW, Shipley RT. Value of computed tomography of the lung in the management of primary spontaneous pneumothorax. Am J Surg 1991;162:39-42 https://doi.org/10.1016/0002-9610(91)90199-N
  3. Janssen JP, Schramel FM, Sutedja TG, et al. Videothoracoscopic appearance of first and recurrent pneumothorax. Chest 1995;108:330-4 https://doi.org/10.1378/chest.108.2.330
  4. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;58 (Suppl 2):39-52 https://doi.org/10.1136/thx.58.suppl_2.ii39
  5. Sihoe AD, Yim AP, Lee TW, et al. Can CT scanning be used to select patients with unilateral primary spontaneous pneumothorax for bilateral surgery? Chest 2000;118:380-3 https://doi.org/10.1378/chest.118.2.380
  6. van Belle AF, Lamers RJ, ten Velde GP, Wouters EF. Diagnostic yield of computed tomography and densitometric measurements of the lung in thoracoscopically-defined idiopathic spontaneous pneumothorax. Respir Med 2001;95: 292-6 https://doi.org/10.1053/rmed.2001.1037
  7. Boutin C, Astoul P, Rey F, Mathur PN. Thoracoscopy in the diagnosis and treatment of spontaneous pneumothorax. Clin Chest Med 1995;16:497-503
  8. Olsen PS, Andersen HO. Long-term results after tetracycline pleurodesis in spontaneous pneumothorax. Ann Thorac Surg 1992;53:1015-7 https://doi.org/10.1016/0003-4975(92)90377-G
  9. Kim MH, Lee CJ, Kim SW. Assessment of primary spontaneous pneumothorax using chest computerized axial tomography. Korean J Thorac Cardiovasc Surg 1993;26: 209-13
  10. Kim JG, Kim KM, Shim YM, et al. Video-assisted thoracic surgery as a primary therapy for primary spontaneous pneumothorax. Decision making by the guideline of highresolution computed tomography. Surg Endosc 1998;12:1290-3 https://doi.org/10.1007/s004649900842
  11. Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest 2005;127:2226-30 https://doi.org/10.1378/chest.127.6.2226
  12. Cardillo G, Facciolo F, Giunti R, et al. Videothoracoscopic treatment of primary spontaneous pneumothorax: a 6-year experience. Ann Thorac Surg 2000;69:357-61 https://doi.org/10.1016/S0003-4975(99)01299-0
  13. Mitlehner W, Friedrich M, Dissmann W. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax. Respiration 1992; 59:221-7 https://doi.org/10.1159/000196062
  14. Geghardt C, Bolcskei P, Wilkening H, Havasy G, Juckenat R. Treatment of spontaneous pneumothorax. Langenbecks Arch Chir 1989;374:156-63 https://doi.org/10.1007/BF01261726
  15. Park YS, Han JY, Chang JW. Diagnostic value of thoracography in pneumothorax. Korean J Thorac Cardiovasc Surg 1998;31:730-4
  16. Lee YJ, Park C, Kim JS, et al. Availability of 2 mm videothoracoscope in bullectomy of primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 2001;34:621-5
  17. Franklin ME Jr, Jaramillo EJ, Glass JL, et al. Needlescopic cholecystectomy: lessons learned in 10 years of experience. Jsls 2006;10:43-6
  18. Lee SA, Kim KT, Park SM, et al. 2 mm video thoracoscopic examination for primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 2000;33:306-9
  19. Hatz RA, Kaps MF, Meimarakis G, et al. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg 2000;70:253-7 https://doi.org/10.1016/S0003-4975(00)01411-9
  20. Morimoto T, Shimbo T, Noguchi Y, et al. Effects of timing of thoracoscopic surgery for primary spontaneous pneumothorax on prognosis and costs. Am J Surg 2004;187:767-74 https://doi.org/10.1016/j.amjsurg.2003.07.032