Jiménez Arribas P, López-Fernández S, Laín Fernández A, Guillén Burrieza G, Lloret Roca J
Servicio de Cirugía Pediátrica. Hospital Universitario Vall d'Hebron. Barcelona.
Cir Pediatr. 2015 Oct 10;28(4):200-204.
Recurrence of spontaneous pneumothorax (SP) is more frequent in pediatric patients. The purpose of our study was to identify factors associated with this recurrence.
Retrospective review of the chart of patients with SP treated at our institution between 2004 and 2014. Statistic methods (χ2 and logistic regression) were used analyzing age, gender, side and size of pneumothorax and therapeutic approach as possible predictive factors of SP recurrence.
A total of 81 SP cases in 43 patients (29 men, 14 women) were reviewed: 50 primary (PSP) and 31 secondary (SSP). Median age at presentation was 15,1 years (0.5-18.59). Follow up was 3.52 years (0.21-18.59). Twenty-three cases (28.4%) underwent surgery (22 thoracoscopies, 1 thoracotomy), consisting of bleb resection with abrasive and chemical pleurodesis. Ipsilateral recurrence after surgery was 21.7% (22.2% in PSP, 20% in SSP, p = 0.096) and 41.4% after non-surgical treatment. Age was a risk factor for recurrence (p= 0.049; OR = 1.16), especially between 10 and 15 years (44.6% in front of 19%, p = 0.013). Male gender and size >20% were associated with higher recurrence risk in SSP that received non-surgical treatment (p<0.05).
Recurrences of SP in children are frequent even after surgical treatment. Age (preadolescence and early adolescence), male gender and initial size of pneumothorax may be factors associated with higher recurrence risk.
小儿自发性气胸（SP）的复发更为常见。我们研究的目的是确定与此复发相关的因素。
回顾性分析2004年至2014年间在我院接受治疗的SP患者病历。采用统计学方法（卡方检验和逻辑回归）分析年龄、性别、气胸侧别和大小以及治疗方法等可能作为SP复发预测因素。
共回顾了43例患者（29例男性，14例女性）的81例SP病例：50例原发性（PSP）和31例继发性（SSP）。就诊时的中位年龄为15.1岁（0.5 - 18.59岁）。随访时间为3.52年（0.21 - 18.59年）。23例（28.4%）接受了手术（22例胸腔镜手术，1例开胸手术），包括肺大疱切除加摩擦和化学性胸膜固定术。术后同侧复发率为21.7%（PSP为22.2%，SSP为20%，p = 0.096），非手术治疗后复发率为41.4%。年龄是复发的危险因素（p = 0.049；OR = 1.16），尤其是10至15岁之间（复发率44.6%，而其他年龄段为19%，p = 0.013）。男性性别和气胸大小>20%与接受非手术治疗的SSP复发风险较高相关（p<0.05）。
即使经过手术治疗，儿童SP的复发仍很常见。年龄（青春期前和青春期早期）、男性性别和气胸初始大小可能是复发风险较高的相关因素。
