Department of Thoracic Surgery, Ebara Hospital, 4-5-10 Higashi-yukigaya, Ota-ku, Tokyo, 145-0065, Japan.
Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan.
Surg Today. 2019 Jul;49(7):587-592. doi: 10.1007/s00595-019-01785-x. Epub 2019 Apr 6.
Primary spontaneous pneumothorax (PSP) generally occurs in young adults, whereas pediatric PSP is uncommon. It is difficult to source reliable data on pediatric PSP, the management of which is based on guidelines for adult PSP; however, the rate of recurrence after video-assisted thoracoscopic surgery (VATS) for pediatric PSP is reported to be higher.
We reviewed retrospectively a collective total of 66 surgical cases of a first pneumothorax episode in 46 children under 16 years of age, who were treated at our hospital between February, 2005 and November, 2017.
The surgical cases were divided into two groups, depending on how the treated lesions were covered. In the dual-covering (DC) group, the PSP was covered by oxidized regenerated cellulose and polyglycolic acid (8 patients; 13 cases) and in the single-covering (SC) group, the PSP was covered by oxidized regenerated cellulose (38 patients; 53 cases). There was no incidence of recurrence after surgery in the DC group, but 17 cases (32.1%) of recurrence after surgery in the SC group. This difference was significant.
The DC method prevented the recurrence of PSP more effectively than the SC method after VATS in pediatric patients. Long-term follow-up after VATS for pediatric PSP is also important because of the risk of delayed recurrence.
原发性自发性气胸（PSP）通常发生在年轻成年人中，而儿童 PSP 则较为罕见。由于难以获取儿童 PSP 的可靠数据，其管理通常基于成人 PSP 的指南；然而，据报道，儿童 PSP 行电视辅助胸腔镜手术（VATS）后的复发率较高。
我们回顾性分析了 2005 年 2 月至 2017 年 11 月期间我院收治的 46 例年龄在 16 岁以下的首次气胸发作的 66 例手术病例。
根据治疗病变的覆盖方式，手术病例分为两组。在双覆盖（DC）组中，PSP 由氧化再生纤维素和聚乙二醇酸（8 例；13 例）覆盖，而在单覆盖（SC）组中，PSP 由氧化再生纤维素（38 例；53 例）覆盖。DC 组术后无复发，而 SC 组有 17 例（32.1%）术后复发。这一差异具有统计学意义。
与 VATS 后儿童 PSP 的 SC 方法相比，DC 方法更有效地预防了 PSP 的复发。由于存在延迟复发的风险，对儿童 PSP 行 VATS 后的长期随访也很重要。
