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1 Centre Valaisan de Pneumologie, Montana, Switzerland. 2 Service de Pneumologie, Hôpital de la Conception, Marseille, France. 3 Afdeling Longziekten, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands. 4 Abteilung für Pneumologie, Universitätskantonsspital, Basel, Switzerland. 5 Service de Pneumologie, Cliniques Universitaires UCL de Mont-Godinne, Yvoir, Belgium, 6 St Elisabeth ZH, Turnhout, Belgium. 7 Divisione di Pneumologia, Spedali Civili, Brescia, Italy
CORRESPONDENCE: J.M. Tschopp, Centre Valaisan de Pneumologie, CH 3962, Montana, Switzerland. Fax: 41 276038181. E-mail: Elisabeth.voland@admin.vs.ch
Keywords: chest tube drainage, cost-effectiveness, primary spontaneous pneumothorax, randomised controlled study, talc pleurodesis, thoracoscopy
Received: September 6, 2001
Accepted April 30, 2002
This study was supported by the Lancardis Foundation, 1920 Martigny, Switzerland.
Simple thoracoscopic talcage (TT) is a safe and effective treatment of primary spontaneous pneumothorax (PSP). However, its efficacy has not previously been estimated in comparison with standard conservative therapy (pleural drainage (PD)).
In this prospective randomised comparison of two well-established procedures of treating PSP requiring at least a chest tube, cost-effectiveness, safety and pain control was evaluated in 108 patients with PSP (61 TT and 47 PD).
Patients in both groups had comparable clinical characteristics. Drainage and hospitalisation duration were similar in TT and PD patients. There were no complications in either group. The immediate success rate was different: after prolonged drainage (>7 days), 10 out of 47 PD patients, but only 1 out of 61 TT patients required a TT as a second procedure. Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients. Pain, measured daily by visual analogue scales, was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates. One month after leaving hospital, there was no significant difference in residual pain or full working ability: 20 out of 58 (34%) versus 10 out of 47 (21%) and 36 out of 61 (59%) versus 26 out of 39 (67%) in TT versus PD groups, respectively. After 5 yrs of follow-up, there had been only three out of 59 (5%) recurrences of pneumothorax after TT, but 16 out of 47 (34%) after conservative treatment by PD. Cost calculation favoured TT pleurodesis especially with regard to recurrences.
In conclusion, thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration, provided there is efficient control of pain by opioids.
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