Therapeutic
Pigtail tube drainage in the treatment of spontaneous pneumothorax

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Abstract

We report our experience in using pigtail tube drainage in the treatment of spontaneous pneumothorax compared with traditional chest tube thoracotomy. One hundred two patients were included and analyzed. Fifty patients were treated with the pigtail tube and 52 patients were treated with the traditional chest tube. The extubation time, mean hospital stay, evacuation rate, and total cost were similar without a significant statistical difference. Among the chest tube group, 15 underwent surgical intervention as a result of delayed resolution and hemopneumothorax; and among the pigtail group, 15 had other procedures for pneumothorax, including chest tube insertion and surgical intervention. This verifies our initial suspicion that the effectiveness of the pigtail drainage system is no less than that of the chest tube. Therefore, when considering ambulatory ability and good patient compliance, the pigtail tube drainage system can be considered as the treatment of choice for spontaneous pneumothorax.

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Patients

We retrospectively collected and reviewed the data of patients with spontaneous pneumothorax treated at China Medical College Hospital from January 1997 to September 2001. The study population was determined by reviewing the charts of patients who were discharged with the diagnosis of spontaneous pneumothorax, excluding congenital, traumatic, tuberculosis, and current lung disease. The individual patient’s chart and chest x-ray (CXR) were carefully reviewed. Only symptomatic patients with a

Tube intubation

The choice of treating spontaneous pneumothorax patients with observation, tube insertion, or surgery was assessed and determined by clinical physicians. In patients undergoing pigtail drainage, a chest echo was performed first for guidance, then the pigtail (8,10 Fr) with a trocar system was inserted into the superior part of the fourth rib at the middle axillary line, after a local anesthesia was injected, and dilated by surgical blade, with the patient in a sitting position.10 The catheter

Results

Among the 102 enrolled patients, the clinical symptoms included chest pain (N = 85, 83.3%), dyspnea (N = 12, 11.7%), and tachypnea (N = 14, 13.7%). Forty-four patients (43.1%) had a right-sided pneumothorax and 58 patients (56.9%) had a left-sided pneumothorax. No significant differences were found between the two groups with respect to the demographic characteristics shown in Table 1.

We examined various data associated with the two procedures. The results (summarized in Table 2) were as

Discussion

The goals of treatment in patients with pneumothorax are relief of pain and respiratory distress in the acute phase, and air evacuation and reexpansion of the lung accomplish this. In asymptomatic patients and those with a small amount of pneumothorax (often less than 20%),2 observation and a close follow-up is often sufficient. However, in patients with a large amount of pneumothorax (over 25%), evacuation of the pleural air is needed. Treatments include simple needle aspiration, chest tube

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