摘要
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/m^2)、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,BM I,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.M ultiple 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,M ultiple 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.
出处
《同济大学学报（医学版）》
CAS
2016年第3期60-65,共6页
Journal of Tongji University(Medical Science)
基金
上海市卫计委重点项目(201540371)
