Dokumcu Zafer, Arslan Serkan, Divarci Emre, Erdener Ata, Ozcan Coskun
Department of Pediatric Surgery, Ege University School of Medicine, İzmir, Turkey.
Eurasian J Med. 2017 Oct;49(3):172-177. doi: 10.5152/eurasianjmed.2017.17080.
Thoracoscopic treatment of pulmonary hydatid cyst (PHC) has been considered to be a good treatment option in both children and adults for nearly 25 years. However, there have been very few pediatric studies published during this period. Our goal is to review our results and evaluate the efficiency of thorascopy in pediatric patients.
The medical records of patients with PHC who were surgically treated between 2005 and 2015 were reviewed. As all cysts larger than 5 cm in diameter were surgically removed, cysts less than 5 cm in diameter were medically treated and were not included in the study. Demographics, cyst characteristics, and operative/postoperative data were compared between patients who underwent thorascopy (thoracoscopy group) and patients who underwent thoracotomy (thoracotomy group). Chi-square and t-test were used for statistical analysis where appropriate.
There were 26 consecutive children (14 girls, 12 boys; mean age 9.4±2.7) included in the study. Except for 2 incidentally diagnosed patients, all were symptomatic, 4 had multifocal lesions, and multiorgan involvement was detected in 11 patients. Thoracoscopy was performed in 10 patients, and conversion was necessary in 2 patients due to unsuccessful fistula ligation attempts. The thoracoscopy group included 8 thoracoscopically treated patients, and remaining patients constituted the thoracotomy group (n=18). Comparison of preoperative characteristics of the groups was insignificant, whereas the overall complication rate (residual bronchial fistula, prolonged air leak, pneumothorax, and localized air cyst) and median hospital stay were significantly higher in the thoracoscopy group. There was no mortality and no recurrence at the postoperative follow-up after 37.4 months.
The thoracoscopic approach to PHC may have a high risk of conversion and postoperative complication rate. Thoracotomy in children still seems to be the approach of choice for PHC larger than 5 cm. Routine thoracoscopic hydatid cyst treatment is yet far from being the gold standard, whereas thoracoscopy may be preferred in selected patients.
近25年来，胸腔镜治疗肺包虫囊肿（PHC）一直被认为是儿童和成人的一种良好治疗选择。然而，在此期间发表的儿科研究非常少。我们的目标是回顾我们的结果并评估胸腔镜在儿科患者中的有效性。
回顾了2005年至2015年间接受手术治疗的PHC患者的病历。由于所有直径大于5 cm的囊肿均通过手术切除，直径小于5 cm的囊肿采用药物治疗，未纳入本研究。比较胸腔镜手术组（胸腔镜组）和开胸手术组（开胸组）患者的人口统计学、囊肿特征以及手术/术后数据。在适当情况下，采用卡方检验和t检验进行统计分析。
本研究连续纳入26例儿童（14例女孩，12例男孩；平均年龄9.4±2.7岁）。除2例偶然诊断的患者外，所有患者均有症状，4例有多灶性病变，11例患者有多器官受累。10例患者接受了胸腔镜手术，2例患者因瘘管结扎尝试失败而需要中转开胸。胸腔镜组包括8例接受胸腔镜治疗的患者，其余患者组成开胸组（n = 18）。两组术前特征比较无显著差异，而胸腔镜组的总体并发症发生率（残留支气管瘘、持续漏气、气胸和局限性气囊肿）和中位住院时间显著更高。术后37.4个月的随访中无死亡病例，也无复发。
胸腔镜治疗PHC可能有较高的中转开胸风险和术后并发症发生率。对于直径大于5 cm的PHC，儿童开胸手术似乎仍是首选方法。常规胸腔镜治疗包虫囊肿远未成为金标准，而在某些特定患者中可能更倾向于选择胸腔镜手术。
