Tönz M, Ris H B, Casaulta C, Kaiser G
Department of Pediatric Surgery, University Hospital Bern, Switzerland.
Eur J Pediatr Surg. 2000 Apr;10(2):88-91. doi: 10.1055/s-2008-1072332.
Video-assisted thoracoscopic debridement has been shown to be a safe and efficient procedure for empyema in the adult patient. Its place in the management of childhood empyema remains controversial.
Over an 18-month period, 9 children were operated upon for pleural empyema. All children were initially treated with appropriate antibiotics and chest-tube drainage. Indication for surgery were persistent clinical symptoms and loculation of pleural fluid 5 to 7 days following initial treatment. In case of a duration of the illness of less than 14 days, an initial attempt was made to debride the pleural space by thoracoscopy.
Mean duration of the illness prior to surgery was 15 days (range: 10-23 days), and mean duration of preoperative conservative treatment 10 days (range: 5-20 days). In five of the nine patients thoracoscopy was performed. In all patients thoracoscopy failed to provide adequate clearance of the diseased pleural space because of the advanced stage of the disease. The procedure was converted to a formal thoracotomy in four patients, the fifth patient continued to deteriorate and required formal thoracotomy and decortication seven days later.
This limited experience suggests that, with the current management and indications, video-assisted thoracoscopic surgery adds little benefit to the treatment of childhood empyema.
电视辅助胸腔镜清创术已被证明是治疗成年患者脓胸的一种安全有效的方法。其在儿童脓胸治疗中的地位仍存在争议。
在18个月的时间里，9名儿童接受了胸腔脓胸手术。所有儿童最初均接受了适当的抗生素治疗和胸腔闭式引流。手术指征为初始治疗5至7天后仍有持续的临床症状和胸腔积液包裹。如果病程少于14天，则首先尝试通过胸腔镜对胸腔进行清创。
手术前的平均病程为15天（范围：10 - 23天），术前保守治疗的平均时长为10天（范围：5 - 20天）。9名患者中有5名接受了胸腔镜检查。由于疾病处于晚期，所有患者的胸腔镜检查均未能充分清理病变的胸腔。4名患者的手术转为正式开胸手术，第5名患者病情持续恶化，7天后需要进行正式开胸手术和胸膜剥脱术。
这一有限的经验表明，按照目前的治疗方法和指征，电视辅助胸腔镜手术对儿童脓胸治疗的益处不大。
