Local pleurodesis plus medical glue assisted argon plasma coagulation via medical thoracoscopy for spontaneous pneumothorax

Background: Most patients with spontaneous pneumothorax(SP) are treated with video-assisted thoracoscopic surgery (VATS) . But it fails to achieve an ideal goal of minimal damage and low cost and may be unsuitable for patients with poor underlying lung condition secondary to COPD. An alternative medical procedure with minimal damage is needed. Aims and Objectives: To explore the efficacy and safety of local pleurodesis plus medical glue assisted argon plasma coagulation (APC) via medical thoracoscopy(MT) in SP patients with subpleural bullae. Methods: The SP patients selected were treated with the following steps.①Adhesiolysis.②Ablating the target bullae with APC.③Spraying medical glue locally on the coagulating sites.④Local pleurodesis(thrombin, erythromycin and 50% glucose injection) on the coagulating sites and lung apex.⑤Chest drain was inserted routinely. Results: 4 patients were included. The average duration of general anesthesia was (97±23)minutes. The postoperative hospitalization time was (10±4) days. The cost was $(2736±675). Ten target bullae(1cm～3cm) were found via MT. The air leak of 2 cases stopped immediately after the treatment while the others stopped on postoperative day 1 and 2 respectively. The transient postoperative fever and chest pain were solved by symptomatic treatment. In the 2 patients with postoperative pleural effusion, pleural drainage was performed in addition. No serious complications occurred. The chest HRCT before discharge showed the target bullae disappeared and the lung reexpanded. Conclusions: Local pleurodesis plus medical glue assisted APC via MT was effective and more minimally invasive in the treatment of SP caused by subpleural bullae.