Катамениальный пневмоторакс как особая форма спонтанного пневмоторакса (обзор литературы)

Abstract

Spontaneous pneumothorax is a common (more than 12.5% of all urgent conditions in thoracic surgery) life-threatening condition, statistically more commonly found in men with pulmonary emphysema. However, a rare and difficult diagnostic form of spontaneous pneumothorax that develops in more than 73% of women of reproductive age with thoracic endometriosis is spontaneous catamenial pneumothorax. In the prevailing majority of patients, this pneumothorax turns out to be right-sided and recurrent in more than 70% of cases. The “gold standard” for verification of thoracic endometriosis is the visual inspection of the chest organs and biopsy using video-assisted mini-thoracotomy (VATS). The signs of thoracic endometriosis detected intraoperatively include the identification of fenestrations of the diaphragm, endometriosis of the visceral pleura, bullae of various calibers, cicatricial changes in lung parenchyma, etc. There is no consensus on the tactics of patients´ management, however, the primary importance in the treatment of thoracic endometriosis and spontaneous catamenial pneumothorax as its main manifestation should be given to surgical interventions: suturing diaphragm defects, typical (anatomical) or atypical resection of the lungs in different volumes, pleurodesis to prevent the recurrence of pneumothorax, etc. The most effective pleurodesis methods are chemical pleurodesis with sterile talc, the use of YAG-ND and CO2 lasers. Apical pleurectomy is actively used; various materials (fibrin gel, polyglycolic acid, etc.) are being studied as suture-line coverage to create aerostasis. Along with surgical methods, the use of COCs, analogues of gonadotropin-releasing hormone, danazole, progestins, and aromatase inhibitors minimizes the recurrence of spontaneous pneumothorax in patients with thoracic endometriosis.