Medical thoracoscopy combined with argon plasma coagulation as an alternative treatment for intractable pneumothorax: a retrospective study.

Background: A significant proportion of patients with pneumothorax who do not tolerate surgery develop intractable pneumothorax after prolonged failure of conservative treatment. This significantly lengthens the duration of hospitalization and patients' quality of life. As the application of medical thoracoscopy (MT) in the management of pleural diseases is explored, MT combined with argon plasma coagulation (APC) may be an alternative option for the treatment of intractable pneumothorax.

Methods: A retrospective analysis was conducted on thirteen patients with intractable pneumothorax whose duration of the air leak exceeded seven days and subsequently treated with MT combined with APC at West China Hospital of Sichuan University. Under MT, we first dissected the pleural adhesions with an electrocautery knife, probed for the rupture located in the pulmonary bullae or pleural and cauterised it with APC. Subsequently, all pulmonary bullae were cauterised and human fibrin sealant was sprayed locally on the cauterised surface. Preoperative, intraoperative, and more than one year of postoperative follow-up information was collected from these patients. We divided the patients into two groups with and without detected ruptures treated under MT to compare the overall efficacy and safety of this treatment.

Results: All patients had pulmonary comorbidities and the median duration of the current pneumothorax episode before MT treatment was 30 days. Nine patients had a history of recurrent pneumothorax episodes, two of whom had been treated with video-assisted thoracoscopic surgery (VATS). Regarding efficacy, the overall median time of time to air leak cessation was 2.5 days, with 2 days in the group with detected ruptures treated and 5 days in the group without detected ruptures treated, and the overall median time of time to chest tube removal was 6 days, with 4 days in the group with detected ruptures treated and 7 days in the group without detected ruptures treated. Regarding safety, only 2 patients experienced postoperative adverse events of fever and chest pain.

Conclusions: For intractable pneumothorax patients with pleural adhesions that may limit lung re-expansion, who are not candidates for surgery, MT combined with APC can be an alternative treatment option.