[Management of secondary pneumothorax]

Abstract

Results on treatment of 445 episodes of 420 patients suffering from spontaneous pneumothorax (sptx) are reported. The overall mortality was 1.4%. No death was encountered during the treatment of 246 primary sptx patients. Mortality of secondary ptx was 3.4%. Detailed data of the recent 92 patients are analysed. Recurrence rate of drainage (ICC) therapy of primary sptx was 8/33. Five out of eight patients were operated on. 16 thoracotomies were performed altogether in this group of patients. 3/18 patients were lost in the ICC treatment only subgroup of secondary sptx panel. 1/25 patient died in the ICC+pleurodesis subgroup of secondary sptx patients. Drainage and subsequent thoracotomy in case of failure of ICC treatment or of numerous recurrences is the choice to follow in primary sptx cases. Apart from exceptions there is no room for chemical pleurodesis in this form of ptx. On the other hand the ICC drainage with pleurodesis offers the best chances in the treatment of secondary sptx. Tetracycline and Vibramycin were proven as the best pleurodesis materials in first instances. Tissucol is recommended to use in case of failure of previous pleurodesis attempts.