[Pleural talc administration under thoracoscopy in the treatment of pneumothorax. Study of a series of 109 cases treated over a 3-year period]

Abstract

There has recently been renewed interest in thoracoscopy. Among its indications we consider talc therapy for a pneumothorax particularly worthy of interest. We report the three year results obtained on a series of 109 pneumothoraces. The indication for thoracoscopy were considered either for a chronic pneumothorax (failure of drainage after 8 days) or for a recurrent pneumothorax. We perform this technique under local anaesthetic with talc therapy given direct vision on the macroscopic lesions encountered. Patients were in hospital for a mean of five days. The results were as follows: Lung appearance. Normal 19%-Dystrophic bullae and giant bullae 41%. blebs: 13%-a visible breach 14%-Diverse anomalies 13%. The immediate failures with talc numbered 6 (5%) each time from the chronic pneumothorax group. They were treated surgically. There were 7 recurrences after talc therapy, 5 were partial recurrences requiring no further treatment and two total relapses were surgically treated. The radiological sequelae appeared minimal. On 5 occasions pleural discomfort hindered the diaphragmatic movement, in the other cases the radiological sequelae consisted of discrete pleural thickening. 42 patients had respiratory function testing and no abnormalities were noted. The failures or recurrences in the talc treated patients were all in the recurrent pneumothorax and were only 13 cases (12%). Thus thoracoscopy is a treatment of choice in the treatment of recurrent pneumothorax, and often replaces surgery. In certain cases (pneumothorax in respiratory failure) it is only possible treatment.