Efficacy of Blood-Patch Pleurodesis for Secondary Spontaneous Pneumothorax in Interstitial Lung Disease
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概要
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Objective We identified the prognostic relevance of pneumothorax in interstitial lung disease (ILD) patients and evaluated the efficacy and safety of autologous blood-patch pleurodesis. Methods We retrospectively reviewed 59 occurrences of pneumothorax in 34 ILD patients identified over a 12-year period. Results Air leakage ceased in 16 of 22 (72.7%) episodes after blood pleurodesis and in 11 of 14 (78.6%) episodes after chemical pleurodesis. Both the cure ratio and recurrence ratio in the cure episodes were comparable with those in the chemical pleurodesis group (p=0.99 and 0.99, respectively). In addition, there were no harmful events associated with blood pleurodesis. The median survival time after the first episode of pneumothorax was less than 9 months in patients with idiopathic interstitial pneumonia (IIP) and only around 3 years in the patients with other types of ILD, which have essentially favorable outcomes. Kaplan-Meier survival estimates were significantly worse in the patients with concomitant pneumomediastinum than in those without (p<0.05). A multivariate Cox regression analysis identified that the number of episodes of pneumothorax, IIP diagnosis and concomitant pneumomediastinum were independent predictors of death. Conclusion Autologous blood-patch pleurodesis is safe and worth considering as a first-line treatment for pneumothorax secondary to ILD. However, despite treatments, the prognosis after the onset of pneumothorax in ILD patients was found to be poor. In addition, concomitant pneumomediastinum may further worsen the prognosis.
著者
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Oga Toru
Department Of Pharmacology Kyoto University Faculty Of Medicine
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HANDA Tomohiro
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
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Tanizawa Kiminobu
Department of Respiratory Medicine, Tenri Hospital
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Chin Kazuo
Department Of Physical Therapeutics Kyoto University
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Mishima Michiaki
Department Of Respiratory Medicine Graduate School Of Medicine Kyoto University
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Harada Yuka
Department Of Hematology/oncology Research Institute For Radiation Biology And Medicine Hiroshima Un
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Hitomi Takefumi
Department Of Neurology Kyoto University Graduate School Of Medicine
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Aihara Kensaku
Department Of Respiratory Medicine Kyoto University Graduate School Of Medicine
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Nagai Sonoko
Kyoto Central Clinic/Clinical Research Center, Japan
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Watanabe Kizuku
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
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Tsuboi Tomomasa
Department of Rehabilitation Medicine, Kyoto University Hospital
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Chihara Yuichi
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Japan
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Aihara Kensaku
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Japan
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Tanizawa Kiminobu
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
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Tanizawa Kiminobu
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Japan
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Hitomi Takefumi
Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan
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Handa Tomohiro
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Japan
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