At the first-line hospital, the doctor diagnosed a right pneumothorax and ordered a chest tube. After 7 days of intensive treatment, the patient's respiratory symptoms improved, but the chest tube still leaked a lot of air. Mr. T. was transferred to Tam Anh General Hospital (HCMC).
On July 15, Master - resident physician Tran Thuc Khang (Department of Cardiovascular - Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital) said that this was a case of spontaneous right pneumothorax, ineffective minimal drainage of the pleural cavity (also known as prolonged air leak). Pneumothorax is often caused by lung parenchyma with ruptured air bubbles or cysts.
For spontaneous pneumothorax, if the amount of air is large and not treated promptly, the patient may suffer from respiratory failure. Treatment for spontaneous pneumothorax is minimal drainage of the pleural cavity. However, for large air bubbles or cysts that cannot be self-sealed, and drainage still results in prolonged air leakage after 5-7 days, surgery should be considered to resolve the cause.
The team performed thoracic endoscopic surgery on the patient, lasting about 60 minutes. Through the endoscopic imaging system, the lesion in the lung parenchyma was identified as consisting of many ruptured and unruptured air bubbles. The lesion was completely removed and the lung parenchyma was sutured using an automatic suturing system. During the surgery, the lung (after removing the air bubble) expanded well, with no air leakage. At the same time, the patient's parietal pleura was cut and mechanically rubbed to create adhesion in the pleural cavity, avoiding future recurrence.
After surgery, the patient recovered quickly, had little pain in the surgical wound, X-ray examination showed good lung expansion, all air leaks were drained and were removed 36 hours after surgery. The patient was discharged after 3 days with normal respiratory status.
Medical history showed that the patient had smoked cigarettes for 15 years and had smoked an average of 1 pack per day for the past few years.
Dr. Khang said that the biggest difficulty in treating spontaneous pneumothorax is that the disease often recurs. If the first drainage is successful, the rate of recurrence of pneumothorax is very high (because there are many other air bubbles that have not ruptured). Depending on the condition of the air leak, whether it is first time or recurrent, and the group of causes (spontaneous or secondary), the doctor will give an appropriate treatment regimen.
In this case, the air leak persists, the patient is indicated for surgery with two purposes: cutting and suturing the air bubbles/cysts and creating adhesions in the pleural cavity to prevent recurrence.
After treatment for lung cysts, patients should rest a lot, avoid activities that require strenuous effort or high-intensity exercise; quit smoking; control associated diseases such as chronic bronchitis, emphysema, chronic obstructive pulmonary disease... to prevent recurrence.
Source: https://thanhnien.vn/cuu-benh-nhan-bi-tran-khi-mang-phoi-gay-kho-tho-dau-nguc-185240715093124634.htm
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