Abdul Aziz Dayang Anita, Abdul Rahman Nur Afdzillah, Tang Swee Fong, Abdul Latif Hasniah, Zaki Faizah Mohd, Annuar Zulfiqar Mohd, Alias Hamidah, Abdul Latiff Zarina
Department of Surgery, National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia.
BMJ Case Rep. 2011 Dec 1;2011:bcr0920114734. doi: 10.1136/bcr.09.2011.4734.
Pulmonary Langerhans cell histiocytosis (LCH) in children is more extensive and is a rare cause of spontaneous secondary pneumothorax (SSP) which tends to be recurrent and refractory to conventional treatment. Its occurrence in paediatric patients posed great challenge to the choice of surgical management. Surgery in the form of pleurodesis is only considered if SSP does not improve after chemotherapy and after considering all relevant risk and benefits of surgery to patients. Chemical pleurodesis will not give the expected effect to eradicate SSP in this patient. Therefore mechanical pleurodesis is the treatment of choice. There are various techniques to perform mechanical pleurodesis; from pleural abrasion to pleurectomy. In the authors' experience, bilateral total pleurectomy provided the best outcome for this 9-year-old patient with persistent respiratory distress from SSP due to extensive pulmonary LCH.
儿童肺朗格汉斯细胞组织细胞增多症(LCH)范围更广,是自发性继发性气胸(SSP)的罕见病因,后者往往会复发且对传统治疗无效。其在儿科患者中的发生给手术治疗的选择带来了巨大挑战。只有在化疗后且考虑到手术对患者所有相关风险和益处后,SSP仍未改善时,才会考虑采用胸膜固定术形式的手术。化学性胸膜固定术对根除该患者的SSP不会产生预期效果。因此,机械性胸膜固定术是首选治疗方法。有多种进行机械性胸膜固定术的技术;从胸膜摩擦到胸膜切除术。根据作者的经验,双侧全胸膜切除术为这名因广泛肺LCH导致SSP而持续呼吸窘迫的9岁患者带来了最佳治疗效果。