Efficacy and safety of position selection combined with intra-pleural thrombin injection in the treatment of postoperative persistent air leakage

Background: Persistent air leakage (PAL) after thoracoscopy is a common complication of spontaneous pneumothorax(SP) and giant emphysematous bulla(GEB),however,resurgical intervention is often limited,and the efficacy of conservative treatments is poor. This study is the first to propose the theory of "position selection",the relative displacement of the lung due to gravity during position changes can be used to promote the close of the visceral and parietal pleura and the mechanical closure of the leak,thus accelerating the healing of the leak. Objective: This study aimed to explore the efficacy and safety of position selection in combination with intra-pleural thrombin injection in the treatment of PAL after medical thoracoscopic (MT) treatment of SP or GEB. Methods: Patients with PAL after MT treatment of SP or GEB received the following treatment procedures ( referred to as "position plus")：①Pleural cavity injection (50% glucose 20ml + thrombin 5000IU).②Changing the patient9s position under continuous negative pressure suction to find the position causing the complete stop or significant reduction of air leakage,and keeping in the position for 24~48 hours.③If the PAL wasn’t stopped after 48 hours,the procedures above would be repeated. Results: 20 patients were included. The average duration of air leakage after"position plus" was (1.32±0.97) days. An average of 1.15 times of pleural cavity injection were required. One patient had recurrent air leakage. No serious complications occurred. Conclusion: The "position plus" is effective,safe and easily operating for the treatment of PAL after MT treatment of SP or GEB.