原发性自发性气胸发病机制及复发原因的研究进展  

Recent research of pathogenesis and causes of recurrence of primary spontaneous pneumothorax

作　　者：单颖军[1] 周永新[2] 

机构地区：[1]同济大学附属东方医院耳鼻喉科,上海200120 [2]同济大学附属同济医院胸心外科,上海200065

出　　处：《外科研究与新技术》2015年第1期52-56,共5页Surgical Research and New Technique

摘　　要：原发性自发性气胸（PSP）是临床常见肺科急症,其典型症状为胸痛、胸闷或呼吸困难。气胸范围较小时,可采用保守治疗,范围较大时需要行胸腔闭式引流术,外科手术是PSP有效的治疗方式,目前主要采用胸腔镜下肺大泡切除术。PSP的发病机制尚不十分明确,多数文献认为肺大泡为气胸的主要危险因素,肺大泡的形成可能与非特异性炎症、瘦高体型及遗传因素等有关。扁平胸一直被认为是青少年发作PSP的危险因素,吸烟与气胸病因学途径紧密相关,可以使气胸患病风险提高,但吸烟并不是气胸的决定性因素。PSP易反复发作,复发率在20%~60%左右。多数学者认为气胸发作的次数越多,复发的概率越高。气胸的复发概率与患者的营养不良状况、气胸的量等相关。术后复发因素可归为患者因素和手术因素两大类。Primary spontaneous pneumothorax（PSP） is common acute disease. Classical symptoms are chest pain,chest distress and dyspnea. An asymptomatic patient with a minimal or small pneumothorax is treated with supplemental oxygen,conservative treatment. Moderate to large pneumothorax are treated by chest tube drainage.Surgery represents the most effective method. Video-assisted thoracoscopic surgery（VATS）is now regarded as the gold standard for the surgical management of PSP. Pathogenesis of PSP has not yet been well elucidated. Most PSP result from spontaneous rupture of a sub-pleural bleb or bulla,which leaks air into the pleural cavity. There are some mechanisms for bleb or bulla formation,nonspecific inflammation,pleural cavity pressure in a tall individual and congenital cause. Flat chest is considered as the risk factor for PSP in adolescent. Smoking is closely related to PSP,and increases the risk of pneumothorax,but smoking is not the determinant. Recurrence is a common and serious problem of PSP,and the recurrence rate has been variably reported as 20%- 60%,and it is related to hypotrophy and the size of pneumothorax. Causes of postoperative recurrence include patient＇s cause and operative cause

关 键 词：自发性气胸 原发性 复发 发病机制 

分 类 号：R655[医药卫生—外科学]