Yeung Fanny, Chung Patrick H Y, Hung Esther L Y, Yuen Chi Sum, Tam Paul K H, Wong Kenneth K Y
Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China .
J Laparoendosc Adv Surg Tech A. 2017 Aug;27(8):841-844. doi: 10.1089/lap.2016.0163. Epub 2017 Jan 18.
Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence.
We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed.
A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007).
Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.
小儿自发性气胸相对少见。由于缺乏基于证据的儿科指南，不同中心的管理策略各不相同。在本研究中，我们回顾了我们对儿童原发性自发性气胸（PSP）进行胸腔镜治疗的经验，并确定了与术后漏气和复发相关的危险因素。
我们对2008年4月至2015年3月期间在我院接受PSP手术治疗的儿科患者进行了回顾性分析。分析了人口统计学数据、影像学检查结果、干预措施和手术结果。
共确定92例患者接受了110次PSP胸腔镜手术。手术指征为非手术治疗失败且持续漏气占32.7%，同侧复发性气胸占36.4%，首次对侧气胸占14.5%，双侧气胸占10%，严重血气胸占5.5%。101例胸腔镜检查（91.8%）发现肺大疱并进行了肺大疱切除术。14.5%的患者术后持续漏气，经重新插入胸腔引流管和化学胸膜固定术治疗。17.3%的患者术后复发，平均复发时间为11个月。症状出现后7天内手术与术后较少漏气相关（P = 0.04）。双侧气胸和影像学特征异常的患者术后漏气（分别为P = 0.002，P < 0.）和复发（分别为P < 0.01，P = 0.007）明显更多。
胸腔引流管插入后早期胸腔镜机械胸膜固定术和肺大疱切除术可作为小儿大量PSP治疗的主要选择，因为这些患者中的大多数被发现肺大疱是病因。
