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儿童肺炎后脓胸的管理

Management of postpneumonic empyemas in children.

作者信息

Demirhan R, Kosar A, Sancakli I, Kiral H, Orki A, Arman B

机构信息

Lutfi Kirdar Kartal Training and Research Hospital, Department of Thoracic Surgery, Erenkoy, Istanbul, Turkey.

出版信息

Acta Chir Belg. 2008 Mar-Apr;108(2):208-11.

Abstract

OBJECTIVE

The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas.

METHODS

From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results).

RESULTS

Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 +/- 3.79 days for group I, 9.08 +/- 2.07 days for group II, and 6.32 +/- 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period.

CONCLUSION

Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.

摘要

目的

小儿脓胸的最佳治疗方法仍存在争议。本临床回顾性研究的目的是评估肺炎后小儿脓胸治疗中的不同治疗方案。

方法

1997年4月至2005年10月,连续111例儿童(57例男孩和54例女孩)接受了胸腔积液脓胸治疗。平均年龄为7.07岁(范围:18个月至14岁)。根据接受的治疗将患者分为3组:第一组,单纯胸腔闭式引流管(n = 89);第二组,胸腔闭式引流管联合纤溶药物(n = 22);第三组,开胸剥脱术(n = 19,其中9例来自第一组,10例来自第二组,治疗效果不佳)。

结果

单纯胸腔闭式引流管、胸腔闭式引流管联合纤溶药物、开胸剥脱术的完全缓解率分别为89.9%、54.5%和100%。第一组的住院时间为11.46±3.79天,第二组为9.08±2.07天,第三组为6.32±2.54天。第一组和第二组在住院时间方面无统计学显著差异(P = 0.040)。第二组有4名儿童在注射链激酶后出现轻度疼痛。第三组术后仅出现1例肺不张。

结论

胸腔闭式引流是肺炎后小儿脓胸安全、有效的主要治疗方法。在引流不足的情况下,开胸剥脱术可成功应用,且发病率和死亡率较低。

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