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首页> 外文期刊>Journal of Thoracic Disease >The effects of total pleural covering on pneumothorax recurrence and pulmonary function in lymphangioleiomyomatosis patients without history of pleurodesis or thoracic surgeries for pneumothorax
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The effects of total pleural covering on pneumothorax recurrence and pulmonary function in lymphangioleiomyomatosis patients without history of pleurodesis or thoracic surgeries for pneumothorax

机译：总胸腔覆盖对淋巴管霉素患者患者气胸复发和肺功能的影响，没有胸腔炎或胸腔手术史

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Background: Total pleural covering (TPC) is an innovative surgical procedure in which the entire visceral pleura is wrapped with sheets of oxidized regenerated cellulose (ORC) mesh under video-assisted thoracoscopic surgery. We have previously reported that TPC could successfully prevent pneumothorax recurrence in patients with lymphangioleiomyomatosis (LAM). However, the actual efficacy and preventive effect of TPC on pneumothorax recurrence remains unclear as many LAM patients already had pleural adhesion prior to TPC that was induced by thoracic surgery and/or pleurodesis. The purpose of this study is to evaluate the effects of TPC on pneumothorax recurrence and pulmonary function in LAM patients with no history of thoracic surgeries or pleurodesis. Methods: We retrospectively reviewed medical charts of 52 patients (60 hemithoraces) who underwent TPC at our center, from January 2003 to September 2019, as a first surgical intervention for pneumothorax. Results: Pneumothorax recurrence occurred in 12 patients [14 of 60 hemithoraces (23.3%)] during the observation period [27 months (14.7; 56.4) = median (lower; upper quartiles)]. The probability of recurrence-free hemithorax post TPC was 81.1% at 2.5 years and 64.1% at 5 years. TPC did not produce a significant decrease in either VC %predicted (pred) or FEV 1 /FVC. The pre- vs. post-TPC median (lower; upper quartiles) VC %pred was 85.7% (79.7; 98.0) vs. 87.2% (72.3; 95.6), P=0.535 and the FEV 1 /FVC was 84.6% (75.7; 89.6) vs. 83.0% (71.8; 87.0), P=0.667. Mechanistic/mammalian target of rapamycin (mTOR) inhibitors (mTORI) were subsequently initiated in 19 patients (36.5%) because of the progression of LAM. The postoperative FEV 1% pred was significantly lower in patients who required mTORI than in those who did not [68.1% (57.3; 82.9) vs. 88.7% (84.6; 89.8), P=0.020]; the decline rate in FEV 1% pred/year from pre to post TPC was significantly greater in LAM patients who required mTORI than in those who did not [?9.37% (?4.73; 12.9) vs. ?1.94% (1.52; ?4.50), P=0.029]. Postoperative complications were found in 25 of 52 hemithoraces (48.1%). Conclusions: TPC can prevent pneumothorax recurrence without causing ventilatory impairment or severe pleural symphysis in LAM patients. TPC is an effective treatment option for LAM-associated pneumothorax based on its efficacy and safety.
机译：背景：总胸膜覆盖物（TPC）是一种创新的外科手术程序，其中整个内脏胸膜胸膜被氧化再生纤维素（ORC）网格包裹在视频辅助胸腔镜手术下。我们此前据报道，TPC可以成功地预防淋巴脊伞症（LAM）患者的气胸复发。然而，由于胸部手术和/或胸膜炎诱导的TPC之前已经具有胸腔粘附，TPC对气胸复发的实际疗效和预防效果仍不清楚。本研究的目的是评估TPC对林患者的肺患者肺炎患者肺炎患者的影响，没有胸腔手术或胸膜瘤病。方法：从2003年1月到2019年1月至2019年9月，我们回顾性地回顾了52名患者（60例半患者）的医学图表，该患者在我们的中心接受了TPC，是2019年1月至9月。结果：在观察期间，12名患者[14名患者[60个中位数（23.3％）]中发生气胸复发[27个月（14.7; 56.4）=中位数（下部;上部四分位数）]。无复发的半胸腔后TPC的概率为81.1％在2.5岁，5年为64.1％。 TPC在VC％预测（Pred）或FEV 1 / FVC中没有产生显着的减少。前TPC中位数（下部;上四分位数）VC％PER值为85.7％（79.7; 98.0）与87.2％（72.3; 95.6），P = 0.535，FEV 1 / FVC为84.6％（75.7 ; 89.6）与83.0％（71.8; 87.0），p = 0.667。随后在19名患者中启动了机械/哺乳动物的雷帕霉素（MTOR）抑制剂（MTORI），因为林的进展是患者（36.5％）。术后FEV 1％pred在需要MTORI的患者中显着降低，而不是在没有[68.1％（57.3; 82.9）与88.7％（84.6; 89.8），p = 0.020];在林患者中，从PRE到TPC前的PEV 1％PRED /年度的下降率在不需要MTORI的林患者中显着更大，而不是那些没有[9.37％（？4.73; 12.9）与Δ1.94％（1.52;？4.50 ），p = 0.029]。术后并发症是在52个半页轴（48.1％）中的25个中发现的。结论：TPC可以防止气胸复发，而不会导致林患者的透气损伤或严重胸膜态联态。 TPC是基于其疗效和安全性的Lam-Cospered气胸的有效治疗选择。

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