The value and safety of CT localization under artificial pneumothorax to predict pleural adhesion before medical thoracoscopic giant emphysematous bulla reduction

Abstract

Background: Pleural adhesion is a major obstacle in thoracoscope surgery, which disturbs lung collapse, adds the risk of lung injury and hemorrhage from a trocar, or results in the failure of surgery and even causes conversion to open surgery in severe cases.

Objective: The study aimed to assess the value and safety of CT localization under artificial pneumothorax to predict pleural adhesion before medical thoracoscopic giant emphysematous bulla reduction(MTGEBR).

Methods: A total of 32 patients (28men and 4 women) who were evaluated with CT localization under artificial pneumothorax before MTGEBR in our hospital from June 2019 to December 2020,with mean age of （60.6±11.1）years, were included retrospectively in the study.

Results: CT localization under artificial pneumothorax demonstrated a positive predictive value of 92.59%,a negative predictive value of 80%,a sensitivity of 96.15%,a specificity of 66.66%,an accuracy of 90.62% for the detection of pleural adhesion. Based on the the CT localization under artificial pneumothorax, the thoracoscopic entry difficulty, lung injury and hemorrhage that might occur in the conventional surgical approach were avoided in all the patients. Complications of artificial pneumothorax were as follows:3 with chest pain, 8 with transient dyspnea, 15 with local small subcutaneous emphysema, 1 with local large subcutaneous emphysema.

Conclusion: CT localization under artificial pneumothorax can effectively display pleural adhesion and its degree. It provides an important and reliable reference for selecting candidates, optimizing surgical approach and reducing the risk of injury in MTGEBR.