To investigate the occurrence and influencing factors of pneumothorax in co-ablation system therapy for pulmonary nodules, and to provide references for optimizing clinical diagnosis and treatment processes and improving treatment safety.

A retrospective analysis was performed on the clinical data of 105 patients with pulmonary nodules who underwent co-ablation system therapy in the Department of Thoracic Surgery of Haidian Hospital of Beijing from October 2024 to March 2025. General patient information, characteristics of pulmonary nodules, surgical operation parameters, and pneumothorax occurrence (including incidence, severity, time of occurrence, and treatment methods) were collected. Independent sample t-test was used for comparison of quantitative data between groups, and chi-square test or Fisher’s exact test was used for qualitative data. Binary logistic regression was used for multivariate analysis of pneumothorax occurrence. A two-tailed P<0.05 was considered statistically significant.

Among the 105 patients, 58 cases (55.2%) developed pneumothorax, with a total of 60 episodes recorded. Specifically, there were 26 mild cases (43.3%), 13 moderate cases (21.7%), 20 severe cases (33.3%), and 1 tension pneumothorax case (1.7%). The majority of pneumothorax occurred intraoperatively (31 episodes, 51.7%) and within 24 hours after surgery (27 episodes, 45.0%), with 2 episodes of delayed pneumothorax (3.3%). Forty-two episodes (70.0%) required thin-tube closed drainage, with an average indwelling time of (4.4±2.5) days. Univariate analysis showed that patients with a history of ipsilateral thoracic surgery (P=0.018), nodules in the left lower lobe (P=0.041), deeper distance from the deep surface of nodules to the pleura (P=0.037), and shorter puncture path (P=0.002) had a lower incidence of pneumothorax. However, factors such as age, gender, smoking history, history of anti-tumor drug use, history of thoracic radiotherapy, size and type of pulmonary nodules, ablation position, and number of ablation needles were not significantly associated with pneumothorax occurrence. The severity of pneumothorax in male patients was higher than that in female patients (P=0.001) .

A history of ipsilateral thoracic surgery, nodules in the left lower lobe, deeper distance from nodules to the pleura, and shorter puncture path from the skin puncture point to the parietal pleura may be protective factors against pneumothorax. After pneumothorax occurs in co-ablation system therapy for a single pulmonary nodule, male patients have a higher severity.