Objectives

Controversy exists regarding the justification of primary surgery in primary spontaneous pneumothorax, and surgery is not free from recurrence. We hypothesized that surgery is a risk factor for contralateral recurrence pneumothorax in adolescent.

Methods

We performed a retrospective cohort study of 163 adolescent with pneumothorax who were treated conservatively with chest tube (n = 100) or chest tube followed by video-assisted thoracoscopic surgery (n = 63) from January 2009 through December 2017.

Results

Ipsilateral recurrence was significantly more common following conservative treatment than surgical treatment (25.0 vs. 3.2%, P < 0.001), while contralateral recurrence was more common in the surgical group than in the conservative group (15.9 vs. 6.0%, P = 0.039). The rates of second episode pneumothorax did not significantly differ between the two treatment groups (P = 0.092). Univariate analysis identified that patients who were treated conservatively had greater risk of ipsilateral recurrence (P = 0.002), while those who proceeded to surgery had greater risk of contralateral recurrence (P = 0.046). No predictors for second episode pneumothorax were found.

Conclusion

To avoid over treatment, we recommend that conservative treatment should be the superior option and CT scan should not be a routine examination in adolescent with their first episode of PSP.

中文翻译：

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手术是青少年原发性自发性气胸对侧复发性气胸的危险因素吗？

目标

关于原发性自发性气胸的初次手术的合理性存在争议，手术并非没有复发。我们假设手术是青少年对侧气胸复发的危险因素。

方法

我们对 2009 年 1 月至 2017 年 12 月接受胸管 ( n  = 100) 或胸管继以电视辅助胸腔镜手术 ( n = 63)保守治疗的 163 名青少年气胸进行了一项回顾性队列研究。

结果

保守治疗后同侧复发明显多于手术治疗（25.0 对 3.2%，P  < 0.001），而手术组对侧复发比保守组更常见（15.9 对 6.0%，P  = 0.039） . 第二次气胸的发生率在两个治疗组之间没有显着差异（P  = 0.092）。单变量分析发现，接受保守治疗的患者同侧复发风险更高（P  = 0.002），而进行手术的患者对侧复发风险更高（P  = 0.046）。没有发现第二次发作气胸的预测因素。

结论

为避免过度治疗，我们建议保守治疗应是最佳选择，CT 扫描不应成为首次出现 PSP 的青少年的常规检查。