Parelkar Sandesh V, Patil Shalil H, Sanghvi Beejal V, Gupta Rahul Kumar, Mhaskar Satej S, Shah Rujuta S, Tiwari Pooja, Pawar Arjun A
Department of Paediatric Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Indian Assoc Pediatr Surg. 2017 Jul-Sep;22(3):150-154. doi: 10.4103/jiaps.JIAPS_167_16.
BACKGROUND/PURPOSE: The aim of our study is to determine efficacy, safety, and feasibility of video-assisted thoracoscopic surgery (VATS) in childhood empyema with a technique of only two ports and open instruments at a tertiary care center in India.
This is a retrospective study of patients below 18 years, with empyema presenting to the Department of Pediatric Surgery of a Tertiary Care Referral Hospital in India, over a period of 9 years who underwent VATS decortication. Only two ports with open surgical instruments were used. The patients were assessed on the basis of mean duration of preoperative symptoms, duration of surgery, average blood loss, postoperative pain relief, complications, and need for redo surgery.
A total of 97 patients underwent primary VATS decortications without inserting an intercostal drainage (ICD) tube and 70 patients as a secondary procedure after ICD tube was inserted. Mean duration of symptoms was 11 days. The average blood loss during surgery was estimated to be 170 cc. The mean duration of surgery was 90 min. The most common postoperative complication was air leak seen in 19.16% of patients. Minor leaks usually settled by 24 h. In eight patients, a negative suction had to be applied to the ICD tube for persistent air leak. The average length of postoperative stay was 4 days. Two patients required a repeat open decortication procedure due to nonresolution of symptoms and poor lung expansion after VATS. Patients had minimal pain and excellent cosmetic outcome after VATS.
Two-port VATS decortication procedure is as feasible and effective as three-port procedure for decortication with better cosmetic result and pain relief.
背景/目的：我们研究的目的是在印度一家三级医疗中心，确定采用仅两个端口及开放器械的电视辅助胸腔镜手术（VATS）治疗儿童脓胸的疗效、安全性及可行性。
这是一项对印度一家三级医疗转诊医院小儿外科9年间收治的18岁以下脓胸患者行VATS纤维板剥脱术的回顾性研究。仅使用两个端口及开放手术器械。根据术前症状的平均持续时间、手术时长、平均失血量、术后疼痛缓解情况、并发症及再次手术需求对患者进行评估。
共有97例患者未插入肋间引流（ICD）管直接接受了初次VATS纤维板剥脱术，70例患者在插入ICD管后接受了二次手术。症状的平均持续时间为11天。手术期间的平均失血量估计为170毫升。平均手术时长为90分钟。最常见的术后并发症是19.16%的患者出现漏气。小的漏气通常在24小时内自行缓解。8例患者因持续性漏气，ICD管不得不持续负压吸引。术后平均住院时间为4天。2例患者因VATS术后症状未缓解且肺扩张不良，需要再次行开放纤维板剥脱术。VATS术后患者疼痛轻微，美容效果极佳。
两端口VATS纤维板剥脱术与三端口纤维板剥脱术同样可行且有效，美容效果更好，疼痛缓解更明显。
