BACKGROUND Pneumothorax is a major complication following endoscopic lung volume reduction with valves with a prevalence of up to 34%. While some patients benefit from valve implantation despite pneumothorax, others are significantly impaired after lung collapse. RESEARCH QUESTION What are the differences in the severity grades of pneumothorax and how does that affect our clinical practice? STUDY DESIGN AND METHODS This single-center retrospective study analyzed patients undergoing endoscopic valve implantation with and without post-interventional pneumothorax. Emphysema characteristics, collateral ventilation, management, and outcome of patients with pneumothorax 3 months after valve implantation were assessed. Pneumothorax was categorized as "severe pneumothorax" (chest tube insertion, prolonged air leak requiring valve removal), "moderate pneumothorax" (chest tube, no valve removal), and "mild pneumothorax" (no chest tube). RESULTS Pneumothorax occurred in 102/532 patients (19%) and was significantly more common after valve placement in the upper lobes (31.3%) compared to the lower lobes (11.3%, p < 0.001). Fissure integrity was significantly higher in patients with pneumothorax (mean 96.6 ± 6.3 % vs. 93.4 ± 10.3 %, p = 0.002). Of all pneumothoraces, 30.4% were mild, 30.4% moderate, 39.2% severe. Severe pneumothorax caused multiple complications and prolonged hospitalization. Valve placement in the left upper lobe and a larger size of the target lobe were identified as risk factors for severe pneumothorax. Patients with pneumothorax developed complete lobar atelectasis in >60% as a sign of therapeutic success, but obviously only when valves could be left in place or re-implanted. However, valve re-implantation resulted in re-pneumothorax in 42.9%. INTERPRETATION Patients could be more individually informed about their risk of pneumothorax, which varies with target lobe location, fissure integrity and re-implantation. The poor outcome and high complication rate of severe pneumothorax calls for future research into the prediction of severe pneumothorax.

中文翻译：

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经验教训：支气管内瓣膜内镜肺减容术后严重气胸的危险因素和临床影响。


背景 气胸是内窥镜下瓣膜肺减容后的主要并发症，患病率高达 34%。虽然一些患者在气胸后仍受益于瓣膜植入，但其他患者在肺塌陷后受到严重损害。研究问题：气胸的严重程度等级有哪些差异，这对我们的临床实践有何影响？研究设计和方法 这项单中心回顾性研究分析了接受内窥镜瓣膜植入术伴和不伴介入后气胸的患者。评估气胸患者瓣膜植入术后 3 个月的肺气肿特征、侧支通气、管理和预后。气胸分为 “重度气胸” （插入胸管，长时间漏气需要移除瓣膜）、 “中度气胸” （胸管插入，无瓣膜移除） 和 “轻度气胸” （无胸管）。结果 气胸发生于 102/532 例患者 （19%），与下肺叶 （11.3%） 相比，上肺叶瓣膜放置后 （31.3%） 明显更常见。气胸患者的裂隙完整性显着升高 （平均值 96.6 ± 6.3 % vs. 93.4 ± 10.3 %，p = 0.002）。在所有气胸中，30.4% 为轻度，30.4% 为中度，39.2% 为重度。严重的气胸导致多种并发症和长期住院治疗。左上叶的瓣膜放置和目标叶的较大尺寸被确定为严重气胸的危险因素。气胸患者在 >60% 中发展为完全性肺叶不张，这是治疗成功的标志，但显然只有当瓣膜可以留在原位或重新植入时。然而，瓣膜再植入导致 42.9% 的再气胸。 解释 患者可以更个体地了解他们患气胸的风险，这因目标叶位置、裂隙完整性和再植入而异。严重气胸的不良预后和高并发症发生率要求未来研究严重气胸的预测。