Sellado de fuga aérea persistente mediante plasma rico en plaquetas intrapleural

Resum

Introduction: Persistent air leak is one of the most frequent postoperative complications and the main indication for surgery in patients with spontaneous pneumothorax. In its management, several therapeutic alternatives are contemplated: surgical procedures such as pulmonary resection surgery or sealing by pleurectomy-chemical pleurodesis; or conservative through talc (slurry), unidirectional valve or administration of autologous blood through the pleural drainage. Hypothesis-Objective: Based on the hypothesis that pleurodesis with PRP can have an adequate safety and efficacy profile for patients with persistent air leakage in relation to conventional treatments, we propose to analyze the sealing rate of air leakage and the recurrence rate after intrapleural administration of platelet-rich plasma in patients with persistent postoperative air leak and in patients with spontaneous pneumothorax. Material and method: Descriptive study of sealing postoperative persistent air leakage or pneumothorax by PRP in 23 patients of the Arrixaca HCUV Thoracic Surgery Service from October 2014 to April 2018, with 28 procedures. Minimum follow-up of 12 months. Results: 23 patients with 28 procedures. 22 men: 1 woman, ages between 13 and 89 years, 19/23 older than 50 years, 19/23 COPD-emphysema. Indication of sealing persistent air leak in 22/23 and 1/23 for pleurodesis. 70% had spontaneous pneumothorax and 30% had a postoperative leak. After the first dose of PRP, the leak was resolved in 86% of the procedures (82.6% of the patients). The procedure is repeated in 5 cases: 2 patients due to persistent leak after PRP, 1 case after surgery, PRP and surgical reoperation; and 2 cases after recurrence within the first 6 months. The overall success rate of air leakage sealing (with one or two PRP procedures) was 96% and one case with surgery. The procedures were well tolerated and were asymptomatic in half of the cases. The complications that were recorded were: Chest pain in 36% grade 2, grade 2 bronchospasm in 1 case (3%) and grade 2-3 loculated pleural effusion in 3 cases (11%) that required intrapleural fibrinolytics. 68% of the procedures were performed with PRP amounts between 120-150 mL, 32% exceeded 150 mL. Complications occurred in all cases (2/2) with volume greater than 200 mL, in 6/7 with volume 150-200 mL and in 6/19 with volume 120-150 mL. Recurrence rate: during the first 6 months, 3 cases were recorded, requiring pleural drainage. Only the procedure was repeated in 2 of them. Recurrence (procedures) at 6 months of 11% and at 12 months of 0%. In relation to the number of patients, the recurrence rate is 13% at 6 months. The minimum post-procedure follow-up was 12 months and a maximum of 51 months, with a median of 29 months, the mortality related to the procedure was 0% and the overall survival was 82.6%. Conclusions: Pleurodesis with platelet rich plasma through pleural drainage tube is a feasible, safe and effective procedure. It decreases the rate of surgical interventions by sealing the air leak in patients with persistent postoperative air leak and with spontaneous pneumothorax secondary to COPD. The PRP can be used as a sclerosing agent repeatedly to achieve the desired effect and as an alternative to the usual chemical agents and adjuvant in complex cases.