SHAN Ying-jun,ZHANG Zhi-qiang,MEI Yun-qing,et al.Factors associated with recurrence of primary spontaneous pneumothorax after initial episode in young patients[J].同济大学学报（医学版）,2016,37(3):60-65. [点击复制]
目的 探索影响中青年患者原发性自发性气胸(primary spontaneous pneumothorax, PSP)首次发作后再次复发的因素,为该疾病的治疗选择提供参考。方法 回顾性分析我院2008年6月至2013年6月年龄在18～35岁,首次发作并有完整资料PSP患者215例,随访12～72个月(38.5±18.6个月)。全组随访期间同侧复发57例(复发组),无同侧复发158例(未复发组),对比两组的各项病例资料: 年龄、性别、BMI指数(kg/m2)、吸烟习惯、首次气胸发作情况、治疗情况、复发时间、发作时CT表现等,明确复发的危险因素。结果 全组215例随访期间有57例同侧复发,复发率为26.51 %。复发组的年龄相对较轻(24.6±4.98 vs. 26.35±5.42,P＜0.05),复发组少量气胸患者的比例较低(P>0.05)。复发组含气病变(91.2% vs. 71.5%,P＜0.05)、肺大泡(47.4% vs. 21.5%,P＜0.05)的比例明显高于未复发组,多发肺大泡(31.6% vs. 12.0%,P＜0.05)和Ⅰ型肺大泡(26.3% vs. 7.0%, P<0.05)的比例复发组明显高于未复发组,复发组胸膜粘连的比例也明显高于未复发组(29.8% vs. 12.7%,P＜0.05),两组在其他方面均无统计学差别。经Cox多元回归分析显示,CT显示含气病变、肺大泡、多个肺大泡、Ⅰ型肺大泡为同侧复发的危险因子(P＜0.05)。结论 对于18～35岁首次发作的PSP患者,同侧复发与CT所见的含气病变、肺大泡、胸膜粘连明显相关,尤其是Ⅰ型肺大泡及多发肺大泡。以上复发危险因素可作为首次PSP发作后患者是否行腔镜手术的参考。
Objective To determine the factors associated with recurrence of primary spontaneous pneumothorax(PSP) after the first episode in young patients. Methods Clinical data of 215 patients aged 18-35 years, who were conservatively treated for initial episode of PSP between June 2008 and June 2013, were retrospectively reviewed. The mean follow-up period was 38.5±18.6 months. Ipsilateral recurrence developed in 57 (26.51%) patients (recurrence group) and there was no recurrence in 158 patients (no-recurrence group). The age, gender, smoking, BMI, side of pneumothorax, type of initial management and CT abnormalities of patients were compared between two groups. Results The age of recurrence group was younger than that of no-recurrence group (24.6±4.98 vs. 26.35±5.42,P＜0.05); and the size of pneumothorax in recurrent group was smaller than that in no-recurrent group. The rates of air-containing lesions (91.2% vs. 71.5%, P＜0.05) and bullae on the CT scan (47.4% vs. 21.5%, P＜0.05) in recurrence group were significantly higher than those in no-recurrence group. The risk of ipsilateral recurrence for patients with or without bullae on CT scans was 40.3% and 19.5%, respectively. Multiple bullae (31.6% vs. 12.0%, P＜0.05), type Ⅰ bullae (26.3% vs. 7.0%, P＜0.05) and pleural adhesions (29.8% vs. 12.7%, P＜0.05) were more common in reccurence group than those in no-recurrence group. Cox regression analysis showed that air-containing lesions, bullae, Multiple bullae, type Ⅰ bullae on the CT scans (P＜0.05) were independent risk factors for ipsilateral recurrence. Conclusion The presence of air-containing lesions, pleural adhesions and bullae on CT scans, particularly multiple bullae and type Ⅰ bullae, after initial episode of PSP are significantly associated with the ipsilateral recurrence in young patients.
