• Journal of Chest Surgery
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• v.43 no.4
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• pp.404-408
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• 2010

Background: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). Material and Method: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). Result: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was $97{\pm}44$ minutes in group A and $77{\pm}18$ minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was $156{\pm}87 cc$ in group A and $147{\pm}87 cc$ in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was $31.7{\pm}25.3$ months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. Conclusion: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

• 보건세계
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• v.43 no.10 s.482
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• pp.4-9
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• 1996

늑골과 횡경막으로 구성되어 있는 흉강안에서 폐가 호흡운동에 따라서 움직이는데 흉강 내면과 폐외면은 벽측흉막과 폐흉막이라는 얇은 막으로 둘러싸여 있다. 이 두 막은 끝에 가서는 서로 합쳐져서 막힌 풍선과 같은 흉막강을 이루는데 정상적으로는 두 막 사이에는 조그마한 공간도 없다(그림1). 이 흉막강 안에는 소량의 흉수가 있어서 기계의 윤활유와 같이 폐가 움직일 때의 마찰을 없애는 작용을 하고 있다. 흉수는 흉강의 안을 싸고 잇는 벽측흉막에서 분비되어서 흉막강을 거쳐서 폐흉막으로 흡수되어 평형상태를 유지하고 있다. 여러가지 이유로 흉수의 분비가 증가하거나 흉수의 흡수가 억제되면 흉막강내에 흉수가 증가하여서 증상을 나타나게 된다.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.485-491
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• 2007

Background: Thoracoplasty has become a rarity in current clinical practice, although it has been widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity. Yet we have perform tailoring thoracoplasty following or concomitant with pulmonary resection in 20 patients. The aim of this study is to evaluate the early and late clinical results and also the significance of tailoring thoracoplasty. Material and Method: From March 1995 to June 2005, modified thoracoplasty following or concomitant with pulmonary resection was performed in 20 patients out of a total of 298 pulmonary resections for closing air leaks and for treating persistent pleural space following pulmonary resections, and to tailor the thoracic cavity to accept a diminished lung volume. Of the 20 patients, 14 patients had tailoring thoracoplasty performed concomitant with pulmonary resection, and the remaining 6 patients also had tailoring thoracoplasty performed following pulmonary resection. The subjects ages ranged from 24 to 77 (mean $59.1{\pm}6.4$) and a male preponderance was noted (17 : 3); the number of left and right surgeries was equal. The preoperative primary underlying diseases were lung cancer in 7 patients, pneumothorax with giant bullous change in 6 patients, bronchiectasis in 2 patients, previous pulmonary tuberculosis associated with aspergilloma in 2 patients, empyema with fibrothorax in 2 patients and multiple lung abscesses & destruction due to previous trauma in 1 patient. The operative methods were apicolysis and subperiosteal removal of the 2nd, 3rd and 4th ribs (the costochondral junction to the posterior portions of the ribs) with preservation of the first rib and compression of the anterior chest via cotton bags and elastic bandages. Result: The mean duration of the air leaks after thoracoplasty was $1.6{\pm}0.2$ days (range: $0{\sim}7$ days) and the mean duration of an indwelling chest tube was 7 days (range: $5{\sim}11$ days); the mean duration of hospitalization was $19.2{\pm}2.8$ days (range: $8{\sim}47$ days). The postoperative complications were wound infection (2) and pneumonia (2); reoperation was done due to bleeding (1) in one patient who underwent concomitant thoracoplasty and there was 1 case of wound infection (1) after postresection thoracoplasty. The mortality was 1 patient in the early phase and 4 patients in the late phase. Conclusion: We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural spaces and to accommodate the diminished lung volume with acceptable cosmetic results when this procedure is combined with pulmonary resection in selected patients.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.936-940
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• 1997

Pulmonary aspergilloma is potentially a life threatening disease resulting from the colonization of lung cavities by Aspergillus fumigatus. A case is reported: a 43-year-old man with symtomatic cavitary aspergilloma presenting with severe productive coughing, hemopt sis, occasional fever, and chilling. On preoperative plain chest radiograph and CT scan, we could find a rounded irregular opacity in a large pulmonary cavity. He received 2 separate operations for therapeutic need. At the first opertion, we performed cavernostomy and thoracoplasty because of severe pleural adhesions, tearing of cavity wall, and high risk of respiratory insufficiency. At the second operation, we performed myoplasty and omentoplasty for closure of remaining air space and complete wrapping of the BPF site. All symptoms of dyspnea and hemoptysis have since resolved. We believed that in the high risk patients who have severe respiratory symptoms, such as in aspergilloma and open cavity with a risk of respiratory insufficiency, cavernostomy followed by myoplasty or omentoplasty should be recommended.