Almaramhy Hamdi H, Allama Amr M
Surgery Department, Faculty of Medicine, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
Saudi Med J. 2015 Sep;36(9):1061-6. doi: 10.15537/smj.2015.9.11326.
To determine predictors for surgical intervention of thoracic empyema in children, and its associated morbidity.
We conducted a retrospective review of medical records of children with empyema thoracis admitted in the Maternity and Children Hospital, Al Madinah Al Munawwarah, Saudi Arabia between January 2007 and January 2012. The data extracted included: socio-demographic data, clinical data, method of treatment, and follow up data. According to the introduced therapeutic methods, a total of 62 patients were divided into 2 groups; patients treated with chest tube (CT) insertion (51 cases), and 11 cases that required thoracotomy (TH); groups were compared to determine predictors for thoracotomy.
Of 62 patients, 37 were females and 25 were males. In terms of age, side of lesion, presence of cough, or dyspnea, both groups were homogenous. Both groups had significant differences for duration of complaint (TH and CT) (13.5±6.5 days versus 10±3.6, p=0.005), presence of fever (90.2% versus 36.4%, p less than 0.001), history of recurrent chest infections (90.9% versus 37.3%, p=0.001), and radiological findings. However, it was not evident that any of these variables influenced treatment decision except absence of fever, which was significantly less in patients treated with thoracotomy.
No specific indicator was found to increase expectancy for surgical intervention as a treatment choice, except the absence of fever, which may reflect the delayed referral and prolonged use of antibiotics and cannot be interpreted truly without caution as an indicator for surgical intervention.
确定儿童胸腔积脓手术干预的预测因素及其相关发病率。
我们对2007年1月至2012年1月在沙特阿拉伯麦地那穆纳瓦拉市妇幼医院收治的胸腔积脓患儿的病历进行了回顾性研究。提取的数据包括：社会人口统计学数据、临床数据、治疗方法和随访数据。根据所采用的治疗方法，将62例患者分为两组；接受胸腔闭式引流管（CT）置入治疗的患者（51例），以及11例需要开胸手术（TH）的患者；比较两组以确定开胸手术的预测因素。
62例患者中，女性37例，男性25例。在年龄、病变侧、咳嗽或呼吸困难的存在方面，两组具有同质性。两组在主诉持续时间（TH组和CT组）（13.5±6.5天对10±3.6天，p = 0.005）、发热情况（90.2%对36.4%，p小于0.001）、复发性胸部感染病史（90.9%对37.3%，p = 0.001）和影像学表现方面存在显著差异。然而，除了发热缺失外，没有明显证据表明这些变量中的任何一个影响治疗决策，接受开胸手术治疗的患者发热缺失情况明显较少。
未发现除发热缺失外的任何特定指标可增加手术干预作为治疗选择的预期，发热缺失可能反映转诊延迟和抗生素使用时间延长，在没有谨慎考虑的情况下不能将其真正解释为手术干预的指标。
