• Journal of Chest Surgery
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• v.35 no.1
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• pp.43-47
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• 2002

Background: With the advances of video technology, thoracoscopic surgery has been applied to various areas of the thoracic surgical fields including major surgeries. Now a days,-thoracoscopic surgery is Performed as a procedure of choice for primary spontaneous pneumothorax. But the operative indication for the primary spontaneous pneumothorax has not been changed since the last few decades, although the procedure of choice was changed from open thoracotomy to thoracoscopy. Therefore, we thought new treatment strategy will be necessary for the management of primary spontaneous pneumothorax. Material and Method: Between January 1998 and December 1999, 149 primary spontaneous pneumothorax patients were admitted to the Kyungpook National University Hospital. Result: Of these patients, 177 were first attack pneumothoraces and the number of total attacks were 250. Conclusion: Analyzing the amount of pneumothorax, methods of treatment, number of recurrences, recurrence rate and hospital stay, we propose a critical pathway for establishing new treatment strategy for the management of primary spontaneous pneumothorax.

• Tuberculosis and Respiratory Diseases
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• v.47 no.3
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• pp.374-382
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• 1999

Background: The aim of this study was to investigate etiologic factor, treatment, prognosis of spontaneous pneumothorax (SP). Material and Methods: The medical records of 225 cases of SP experienced at Kyungpook University Hospital from Jan. 1996 to Dec. 1997 were retrospectively analyzed. Results: The patients were 128 primary SP and 97 secondary SP. The mean age was $30{\pm}15.5$ years in primary SP and $51{\pm}7.4$ years in secondary SP. The ratio of male to female was 8:1 in primary SP and 5.5:1 in secondary SP. Smoker was more common in seconday SP (71.1 %) than primary SP (34.4%). About 70% of patients with primary and secondary SP was underweighted. The previous history of SP was present in 28.9% and 25.8% of primary and secondary SP, respectively. The main underlying lung diseases in secondary SP were inactive tuberculosis (68%), active tuberculosis (12.4%) and COPD (11.3%). Tube thoracostomy was performed in 96.8% and 97.9% of primary and secondary SP, respectively. The duration of chest tube insertion was longer in seconday SP ($18.2{\pm}19.59$ days) than primary SP ($7.5{\pm}6.57$ days). The open thoracotomy were performed in 22.7% and 10.3% of primary and secondary SP, respectively. The most com- mon indication of open thoracotomy was recurrence in primary SP and persistent air leak in secondary SP. During following-up of $17{\pm}7.8$ months, the recurrence rate in patients with conservative treatment was 16.5% and 11.8% of primary and secondary SP, respectively. The recurrence was most common within 1 month after discharge. Conclusion: Greater attention and research about SP are necessary for more efficient patient care.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.535-538
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• 2003

Spontaneous pneumothorax accompanying primary lung cancer is rare and its occurrence as an initial sign of primary lung cancer is much rarer. A few articles on spontaneous pneumothorax accompanying lung cancer have been published in Korea so far. Lung cancers, diagnosed after spontaneous pneumothorax, are usually in advanced stage, so that conservative treatment modalities such as closed tube thoracostomy, chemotherapy, or radiotherapy are the mainstream of the treatment. We experienced a case of local recurrence of primary lung cancer in six months after radical resection and radiotherapy of neoplasm performed immediately after the diagnosis by excisional biopsy of bulla, for which resection and pleurodesis had been done under the impression of spontaneous pneumothorax. In this paper, we report the case and follow-up observation of the patient.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.260-263
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• 2001

비디오흉강경을 통한 기포절제술이 술후 통증, 창상으로 인한 감염등의 합병증을 줄였고, 미관상의 효과와 더불어 짧은 입원기간으로 빠른 사회로의 복귀를 가져왔다. 1999년 11월 18일부터 2000년 4월 19일까지 6개월동안 수술적응증이 되는 20례의 원발성 자연기흉 환자를 개흉술로의 전환 없이 2mm 비디오 흉강경을 이요하여 기포 절제술을 시행하였다. 수술창성은 단순 흉강삽관술을 시행하였을때와 거의 흡사했다. 원발성 자연기흉 환자에서는 병변이 상엽에 국한되어 있는 경우가 대부분이고, 늑막유착이 없거나 심하지 않아서 2mm비디오 흉강경으로도 기포절제술이 가능하게 되어 수술창상을 줄일수 있었다.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.394-398
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• 2006

Background: Goal of the initial treatment of primary spontaneous pneumothorax is re-expansion of the lung by evacuation of air from pleural space. Authors thought small caliber catheter could reach to this goal instead of conventional large bore chest tube. This retrospective study was undertaken to assess the effectiveness of 7-French (Fr) catheter for the initial treatment of primary spontaneous pneumothorax. Material and Method: Between May 2003 and April 2005, 111 patients with primary spontaneous pneumothorax were managed with tube drainage; 7 Fr catheter for 86 patients and 24-French chest tube for 25 patients. We analyzed catheter indwelling time, use of analgesics, re-expansion of the lung, and catheter related problems by medical records. Result: Mean catheter indwelling time was $2.4{\pm}1.1$ days in 7 Fr group and $2.3{\pm}1.3$ days in chest tube group (p>0.05). All patients with 24 Fr catheter needed analgesics injection but never in 7Fr group. Complete re-expansion of the lung based on plane chest radiograph was obtained in 77% of 7 Fr group. The problem related with 7 Fr catheter was kinking, which showed in 5.6%. Conclusion: Application of the 7 Fr catheter for initial management of primary spontaneous pneumothorax was as effective as 24 Fr catheter.

• Proceedings of the KTCVS Conference
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• 1998.10a
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• pp.107-107
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• 1998

• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.135-135
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• 1995

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1094-1104
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• 1997

Background : Spontaneous pneumothoraces(SP) are divided into primary spontaneous pneumothoraces (PSP) which develop in healthy individuals without underlying pulmonary disorders and secondary spontaneous pneumothoraces(SSP) which occur in those who have underlying disorders such as tuberculosis or chronic obstructive lung diseases. Yet there is no established standard therapeutic approach to this disorder, i.e., from the spectrum of noninvasive treatment such as clinical observation with or without oxygen therapy, to aggressively invasive thoracoscopic bullectomy or open thoracotomy. Although chest tube thoracostomy has been most widely used, the patients should overcome pain in the initiation of tube insertion or during indwelling it potential infection and subcutaneous emphysema. Thus smaller-caliber tube has been challenged for the treatment of pneumothorax. Previously, we studied the therapeutic efficacy of 8 French catheter for spontaneous pneumothorax. But there has been few data for effectiveness of small-caliber catheterization in comparison with that of chest tube. In this study, we intended to observe the long-term effectiveness of 8 French catheter for the treatment of spontaneous pneumothoraces in comparison with that of chest tube thoracostomy. Method : From January, 1990 to January, 1996, sixty two patients with spontaneous pneumothoraces treated at Chung-Ang University Hospital were reviewed retrospectively. The patients were sub-divided into a group treated with 8 French catheter(n=23) and the other one with chest tube insertion(n=39). The clinical data were reviewed(age, sex, underlying pulmonary disorders, past history of pneumothorax, size of pneumothorax, follow-up period). And therapeutic effect of two groups was compared by treatment duration(duration of indwelling catheter or tube), treatment-associated complications and recurrence rate. Results : The follow-up period(median) of 8 French catheter group and chest tube group was 28 and 22 months, which had no statistical significance. Ther was no statistically significant difference of clinical characteristics between two groups with SP, PSP, SSP. The indwelling time of 8 French catheter group was $6.2{\pm}3.8$ days, which was significantly shorter than that of chest tube group in SP, $9.1{\pm}7.5$ days(p=0.047). In comparison of treatment-related complication in PSP, 8 French catheter group as 6.25% of complication showed lower tendency than the other group as 23.8% (p=0.041 ; one-tailed, p=0.053; two-tailed). The recurrence rate in each group of SP was 17.4%, 10.3%, which did not show any statistically significant difference. Conclusion : Treatment with 8 French catheter resulted in shorter indwelling time in sponteous pneumothorax, and lower incidence of treatment-related complication in primary spontaneous pneumothorax. And the recurrence rate in each of treatment group showed no statistically significant difference. So, we can recommend the 8 French small-caliber catheter for the initial therapy for spontaneous pneumothorax for the replacement of conventional chest tube thoracostomy. But further prospective study with more subjects of spontaneous pneumothorax will be needed for the evaluation of effectiveness of 8 French cateter.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.438-443
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• 2004

Background : The treatment strategy for urinary spontaneous pneumothorax has progressively changed with the introduction of video-assisted thoracic surgery (VATS). Recently, we modified the strategy of primary spontaneous pneumothorax. If the patient had mild dyspnea and the lung was minimally collapsed, 2 mm thoracoscopic examination was performed. If no blob or bullae was inspected, the intrathoracic air was evacuated through the 2 mm thoracoscopic troca without closed thoracostomy, and if the blob and bullae was noted, the 10 mm thoracoscopic bullecotomy was carried out immediately and also application of fibrin glue was substituted for pleural abrasion. We compared the clinical outcomes of modified treatment strategy with conventional strategy in primary spontaneous pneumothorax. Material and Method: Patients were divided into four groups. Group I (n=21) underwent 2 mm thoracoscopic examination. Group II (n=68) underwent closed thoracostomy. Group III (n=56) underwent VATS and application of fibrin glue. Group IV (n=87) underwent VATS and pleural abrasion. The duration of chest tube drainage, the duration of hospitalization and the recurrence rate were compared between group I and group II and between group III and group IV. Result: Mean age, sex, location of pneumothorax were not different in all groups. In group I, the blob or bullae were existed in 12 patients, In remaining 9 patients, the bleb or bullae was not inspected. The mean duration of hospitalization in 9 patients were 2.4 $\pm$1.0 day and in group II were 3.9$\pm$2.1 day (p=0.014). There was 1 case of recurrence among the 9 patients in group I and 26 recurrences in group II (p=0.149). The mean duration of chest tube drainage were not difference in group III and IV (group III: 2.8$\pm$1.8 day, group IV: 3.0$\pm$2.5 day). The mean duration of hospitalization was shorter in group III than group IV (group III: 5,6$\pm$2.7 day, group IV: 1.3$\pm$3.3 day)(p=0.002). There was no recurrence in group III and 7 recurrences in group IV (p=0.043). Conclusion: Our modified treatment strategy of primary spontaneous peumothorax was effective in short hospital course and low recurrence rate.

• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.92-92
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• 1995