Objective: To investigate the treatment for postoperative recurrence of spontaneous pneumothorax, the feasibility of re-operation, indications and the results.
Method: The clinical and follow-up data of 28 cases of postoperative recurrence from 485 patients who underwent operations for spontaneous pneumothorax from Jan, 1994 to Jan, 2005 were retrospectively reviewed.
Results: One case was observed without any invasive therapy, 12 cases underwent closed pleural drainage and 15 cases received reoperation. All of the patients had the lungs reexpanded sufficiently, with comorbidities in 2 cases, one of which was pleural effusion, the other was prolonged leakage after surgery. No death occurred. The operation time was 80 - 315 (115 +/- 43) min, and the bleeding volume was 50 - 350 (115 +/- 54) ml. The time of chest tube drainage was 1 - 7 (4 +/- 2) d, and the time of hospital stay was 7 - 18 (11 +/- 5) d. The follow-up of the 28 cases ranged from 1 to 107 months (median 55.4) without recurrence.
Conclusions: The findings on lung high rate CT (HRCT) are the most important factors in deciding treatments of postoperative recurrence of pneumothorax. If it is the first recurrence, and there is no evident bullae on HRCT, conservative therapy should be considered, especially for the recurrence within two years postoperation. If the first recurrence occurs after surgery, especially within 2 years, and the bullae is invisible on HRCT, adhesion is the choice without significant adverse effect. If the recurrence occurred twice and more, bullae is found on HRCT, adhesion hampered lung reexpansion, or pleural drainage alone could not work, re-operation should be performed.