Chen Chien-Yi, Chen Jin-Shing, Huang Li-Min, Lee Ping-Ing, Lu Chung-Yi, Lee Yung-Chie, Lu Frank Leigh
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2003 Dec;102(12):845-50.
The appropriate type of intervention for the treatment of empyema in children remains controversial. This study analyzed whether video-assisted thoracoscopic debridement (VATD) as first-line treatment is effective in the management of pediatric parapneumonic empyema.
We retrospectively reviewed the medical and microbiological records of pediatric patients with parapneumonic empyema diagnosed at a medical center from January 1995 to December 2002. The 55 patients included in this study were initially treated with either tube thoracostomy drainage (TTD group [n = 37]) or video-assisted thoracoscopic debridement (VATD group [n = 18]).
A comparative analysis found no significant difference in patient characteristics between these 2 groups. Patients in the VATD group had a significantly shorter duration of fever (18.9 +/- 1.7 vs 26.9 +/- 1.3 days), chest tube placement (5.3 +/- 0.7 vs 15.2 +/- 2.0 days), antibiotic therapy after the procedure (12.2 +/- 1.0 vs 26.3 +/- 2.8 days), and hospital stay (21.5 +/- 2.1 vs 33.2 +/- 2.8 days). No additional procedures were required in the VATD group, whereas 65% (24/37) of patients in the TTD group underwent salvage VATD.
Primary management using video-assisted thoracoscopic decortication was more effective and reduced the duration of illness in pediatric patients with parapneumonic empyema.
儿童脓胸的恰当治疗干预类型仍存在争议。本研究分析了电视辅助胸腔镜清创术（VATD）作为一线治疗方法在小儿肺炎旁胸腔积液治疗中的有效性。
我们回顾性分析了1995年1月至2002年12月在某医疗中心诊断为肺炎旁胸腔积液的儿科患者的医疗和微生物学记录。本研究纳入的55例患者最初接受了胸腔闭式引流术（TTD组[n = 37]）或电视辅助胸腔镜清创术（VATD组[n = 18]）治疗。
对比分析发现这两组患者的特征无显著差异。VATD组患者的发热持续时间（18.9±1.7天对26.9±1.3天）、胸管留置时间（5.3±0.7天对15.2±2.0天）、术后抗生素治疗时间（12.2±1.0天对26.3±2.8天）和住院时间（21.5±2.1天对33.2±2.8天）均显著缩短。VATD组无需额外手术，而TTD组65%（24/37）的患者接受了挽救性VATD。
对于小儿肺炎旁胸腔积液患者，采用电视辅助胸腔镜剥脱术进行初始治疗更有效，且缩短了病程。
