Meier Andreas H, Hess Clayton B, Cilley Robert E
Division of Pediatric Surgery, Department of Surgery, School of Medicine, Southern Illinois University, PO Box 19665, Springfield, IL 62794-9665, USA.
Pediatr Surg Int. 2010 Apr;26(4):367-71. doi: 10.1007/s00383-010-2562-0. Epub 2010 Feb 11.
Video-assisted thoracoscopic debridement (VATD) is a well-established intervention to treat pediatric empyema. There is ongoing controversy at what stage in the treatment algorithm it should be utilized. To shed further light onto this debate, we reviewed our institutional experience looking for factors predicting treatment failure or complications of VATD.
We retrospectively analyzed data on patients that had undergone VATD for empyema from 1995 to 2008. We used independent sample t tests and Chi-square tests (SPSS) for statistical analysis.
One hundred and fifty-two procedures in 151 patients [81 male (53.6%)] were identified. In 146 (96.7%) the etiology of the empyema was pulmonary, in 3 (1.98%) due to an infectious abdominal process and in 2 (1.3%) due to abdominal trauma. 118 patients (78.1%) were transferred from outside hospitals. 107 (70.1%) underwent VATD primarily, 44 (29.1%) following another procedure. The overall complication rate was 13.8%, most of which were minor. Treatment failures occurred in seven patients, resulting in three reoperations; two patients died. The average length of stay was 10.1 days, but was significantly longer if VATD followed another procedure or if a complication occurred. The risk for complications correlated with older age (6.2 vs. 8.8 years, p = 0.023) and lower hematocrit on admission (31.1 vs. 27.9%, p = 0.006).
VATD provided effective treatment for pediatric empyema. Complications were mostly minor, occurring more frequently in older patients and those with a lower admission hematocrit. Early VATD decreased the length of hospitalization.
电视辅助胸腔镜清创术（VATD）是治疗小儿脓胸的一种成熟干预措施。在治疗方案的哪个阶段应采用该方法仍存在争议。为进一步阐明这一争论，我们回顾了本院的经验，寻找预测VATD治疗失败或并发症的因素。
我们回顾性分析了1995年至2008年因脓胸接受VATD治疗的患者数据。采用独立样本t检验和卡方检验（SPSS）进行统计分析。
共确定了151例患者的152例手术[81例男性（53.6%）]。146例（96.7%）脓胸病因是肺部的，3例（1.98%）是由于腹部感染性疾病，2例（1.3%）是由于腹部创伤。118例患者（78.1%）从外院转入。107例（70.1%）主要接受了VATD，44例（29.1%）在接受另一种手术后接受了VATD。总体并发症发生率为13.8%，大多数为轻微并发症。7例患者治疗失败，导致3例再次手术；2例患者死亡。平均住院时间为10.1天，但如果VATD在另一种手术后进行或发生并发症，则住院时间明显延长。并发症风险与年龄较大（6.2岁对8.8岁，p = 0.023）和入院时血细胞比容较低（31.1%对27.9%，p = 0.006）相关。
VATD为小儿脓胸提供了有效的治疗。并发症大多为轻微并发症，在年龄较大的患者和入院时血细胞比容较低的患者中更常见。早期VATD可缩短住院时间。
