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Abstract：
BACKGROUND: Multiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has emerged as an alternative aiming to minimize surgical morbidity. This study aims to strengthen the evidence on the safety and efficiency of uVATS compared to mVATS.
METHODS: From January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes).
RESULTS: A total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes.
CONCLUSIONS: This study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.
METHODS: From January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes).
RESULTS: A total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes.
CONCLUSIONS: This study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.
摘要：
背景：多门胸腔镜手术（mVATS）是手术治疗自发性气胸的标准方法。然而,单通道VATS（uVATS）已成为一种旨在将手术发病率降至最低的替代方法。这项研究旨在加强与mVATS相比，uVATS的安全性和有效性的证据。
方法：从2004年1月至2020年12月，对接受原发性或继发性自发性气胸手术治疗的患者记录进行了资格评估。包括通过uVATS或mVATS进行胸膜切除术联合大泡切除术或根尖楔形切除术的患者。比较了通过uVATS或mVATS进行手术的患者的手术特征和术后数据。进行单变量和多变量分析以确定手术方式是否与任何并发症（主要结果）相关。主要并发症(即，Clavien-Dindo≥3),复发,延长住院时间或延长胸腔引流时间(次要结局).
结果：共纳入212例患者。通过uVATS（n=71）和mVATS（n=141）治疗的患者气胸类型显着不同（继发性自发性；uVATS：54[76％]，mVATS:79[56%];p=0.004)。两组之间的（主要）并发症和复发率没有显着差异。多变量分析显示，手术方法对主要或次要结局没有显著预测。
结论：本研究表明，在自发性气胸的手术治疗中，uVATS在安全性和有效性方面不劣于mVATS。因此，uVATS方法有可能进一步改善自发性气胸的围手术期手术护理。
方法：从2004年1月至2020年12月，对接受原发性或继发性自发性气胸手术治疗的患者记录进行了资格评估。包括通过uVATS或mVATS进行胸膜切除术联合大泡切除术或根尖楔形切除术的患者。比较了通过uVATS或mVATS进行手术的患者的手术特征和术后数据。进行单变量和多变量分析以确定手术方式是否与任何并发症（主要结果）相关。主要并发症(即，Clavien-Dindo≥3),复发,延长住院时间或延长胸腔引流时间(次要结局).
结果：共纳入212例患者。通过uVATS（n=71）和mVATS（n=141）治疗的患者气胸类型显着不同（继发性自发性；uVATS：54[76％]，mVATS:79[56%];p=0.004)。两组之间的（主要）并发症和复发率没有显着差异。多变量分析显示，手术方法对主要或次要结局没有显著预测。
结论：本研究表明，在自发性气胸的手术治疗中，uVATS在安全性和有效性方面不劣于mVATS。因此，uVATS方法有可能进一步改善自发性气胸的围手术期手术护理。
