演題

IS-9-5

Video-assisted Thoracoscopic Instillation of Fibrin Glue into Ruptured Bulla for Refractory Secondary Pneumothorax

[演者] 岡林 寛:1
[著者] 山本 玲央那:1, 山本 耕三:1, 徳石 恵太:1, 濱田 利徳:1, 岩崎 昭憲:2
1:国立病院福岡東医療センター呼吸器外科, 2:福岡大学呼吸器・乳腺内分泌・小児外科

Background: Patients with secondary pneumothoraces generally have serious comorbid disease and poor pulmonary function and they require individualized treatments. Though interventional treatments such as tube thoracostomy and pleurodesis are done first, some cases become refractory. When VATS treatment is attempted finally, sometimes it is out of standard surgical manners. Purpose: We present here our VATS technique to control refractory air leak by direct infusion of fibrin glue (FG) via double lumen catheter into ruptured bulla, sometimes with polyglycolic acid (PGA) sheet. Methods: 1) VATS is introduced with general anesthesia, 2) detect the focus, 3) confirm that stapling is not good for the lesion, 4) ensure surgical margin to afford tie, 5) enlarge the air-leak hole or make a new hole to introduce a catheter, 6) FG infusion via a double lumen catheter repeatedly, 7) if the bulla is large, a piece of PGA sheet is inserted alternately, 8) close the hole for catheter, 9) additional pleurodesis. Results: This operation was performed at our institution 13 times for 12 patients with uncontrolled secondary spontaneous pneumothoraces. Underlying diseases were COPD in 9, interstitial pneumonia (IP) in 3 and non-tuberculous mycobacterium (NTM) in 1. Air-leak could be perfectly controlled after this procedure in all cases. Chest tube could be withdrawn within 5 days after surgery and no serious morbidity was occurred. Conclusions: This FG instillation technique into ruptured bulla encourages us to perform the VATS for the patients with refractory pneumothoraces. This seems feasible and improves patients quality of life.
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