Noh Dongsub, Lee Sungsoo, Haam Seok Jin, Paik Hyo Chae, Lee Doo Yun
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
Interact Cardiovasc Thorac Surg. 2015 Aug;21(2):195-9. doi: 10.1093/icvts/ivv104. Epub 2015 Apr 29.
Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children.
A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years.
The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764).
In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children.
尽管更好的营养支持提高了儿童的生长速度，但儿童原发性自发性气胸的发生率也在上升。本研究旨在调查原发性自发性气胸的发生和复发情况以及手术治疗原发性自发性气胸在青少年和儿童中的疗效。
2006年1月至2010年12月期间，我院共840例气胸患者接受治疗。本研究的排除标准为年龄>25岁或继发性、创伤性或医源性气胸，共纳入517例患者。根据原发性自发性气胸首次发作时的年龄，将患者分为三组：A组：≤16岁；B组：17 - 18岁；C组：≥19岁。
研究组由470例男性和47例女性患者组成。有234例右侧、279例左侧和4例双侧原发性自发性气胸。285例患者接受了电视辅助胸腔镜手术楔形切除术，232例采用观察或闭式胸腔引流术治疗。在楔形切除术组中，51例患者复发。楔形切除术后的复发率在A组为27.9%，B组为16.5%，C组为13.2%（P = 0.038）。观察或闭式胸腔引流术后的复发率在A组为45.7%，B组为51.9%，C组为47.7%（P = 0.764）。
在本研究中，术后复发率高于文献报道。密集和长期的随访可能是复发率相对较高的一个原因。≤16岁患者楔形切除术后的复发率高于年龄较大的患者。观察或闭式胸腔引流术后的复发率在各年龄组之间无差异。这些结果表明，儿童可能应推迟进行楔形切除术。
