Williams Kibileri, Lautz Timothy B, Leon Astrid H, Oyetunji Tolulope A
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611.
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611.
J Pediatr Surg. 2018 Sep;53(9):1858-1861. doi: 10.1016/j.jpedsurg.2017.11.047. Epub 2017 Nov 23.
There is no consensus in the pediatric surgical community about when to recommend video-assisted thoracoscopic surgery (VATS) for patients with primary spontaneous pneumothorax (PSP). We aimed to identify factors that predict the likelihood of requiring VATS, and to compare recurrence rates and healthcare utilization among different management approaches to PSP.
A retrospective chart review and a telephone survey were conducted on all patients 12-21years who were diagnosed with PSP from 2007 to 2015. Data were extracted on patient demographics, initial management, hospital length of stay (LOS), and subsequent admissions, procedures, and recurrences.
A total of 46 patients were included with a mean age of 16.1years (+/- 1.2). Most patients were male (41, 89%) and white (16, 44%). Initial management comprised chest tube drainage alone in 28 (61%), no intervention in 8 (17%), and VATS in 10 (22%). Total LOS was 6days (IQR 4-7) and was longer in patients who underwent VATS (p<0.001). Recurrence occurred in 17 patients (37%). However, recurrence and healthcare utilization were not significantly associated with initial management approach. Among those who had initial chest tube drainage, 14 (50%) underwent VATS on that admission, and 8 (28%) had subsequent surgery. Significant predictors of ultimately requiring VATS were presence of an air leak and partial lung expansion.
Most patients with PSP currently undergo chest tube placement as initial management, although most eventually require VATS. Presence of an air leak and partial lung expansion on chest radiograph within the first 48h of management should prompt earlier surgical intervention.
Retrospective.
III.
在小儿外科领域，对于原发性自发性气胸（PSP）患者何时推荐电视辅助胸腔镜手术（VATS）尚无共识。我们旨在确定预测需要VATS可能性的因素，并比较PSP不同管理方法的复发率和医疗资源利用情况。
对2007年至2015年诊断为PSP的所有12 - 21岁患者进行回顾性病历审查和电话调查。提取患者人口统计学、初始管理、住院时间（LOS）以及后续入院、手术和复发情况的数据。
共纳入46例患者，平均年龄16.1岁（±1.2）。大多数患者为男性（41例，89%）且为白人（16例，44%）。初始管理包括单纯胸腔闭式引流28例（61%），未干预8例（17%），VATS 10例（22%）。总住院时间为6天（四分位间距4 - 7天），接受VATS的患者住院时间更长（p<0.001）。17例患者（37%）复发。然而，复发和医疗资源利用与初始管理方法无显著关联。在初始接受胸腔闭式引流的患者中，14例（50%）在此次入院时接受了VATS，8例（28%）随后进行了手术。最终需要VATS的显著预测因素是漏气和部分肺膨胀。
目前大多数PSP患者初始管理采用胸腔置管，尽管大多数最终需要VATS。在管理的最初48小时内胸部X线片显示漏气和部分肺膨胀应促使更早的手术干预。
回顾性。
III级。
