胸腔镜在儿童脓胸 3 期的应用-一种替代开胸术的安全可行方法。
Thoracoscopy in stage 3 empyema thoracis in children - A safe and feasible alternative to thoracotomy.
机构信息
Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore - 560029, Karnataka, India.
Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore - 560029, Karnataka, India.
出版信息
J Pediatr Surg. 2020 Apr;55(4):756-760. doi: 10.1016/j.jpedsurg.2019.08.007. Epub 2019 Aug 28.
BACKGROUND
Even though the role of thoracoscopy is well defined in Stage 2 empyema thoracis and is very popular, its role in the management of advanced empyema is still unclear. The technical difficulties and the potential complications are the principal reasons for the hesitancy in attempting video assisted thoracoscopic surgery (VATS) in advanced stages.
METHODS
We prospectively studied the safety, feasibility and effectiveness of VATS for decortication in Stage 3 empyema.
RESULTS
In the 61 cases that we attempted VATS over the last 7 years, we could complete the procedure in 45 patients (73.77%). Four children among them required re-do procedure later for persistent problems. Conversion to thoracotomy was needed in 16 patients (26.23%). The post-operative hospital stay of patients who underwent primary VATS decortication was significantly less when compared to patients requiring conversion (p < 0.0001).
CONCLUSION
Thoracoscopy is a safe, feasible and effective option even in advanced empyema thoracis and should be offered in centers with adequate expertise and set up.
LEVEL OF EVIDENCE
Level II.
背景
尽管胸腔镜在 2 期脓胸的治疗中作用明确且非常流行，但在治疗晚期脓胸方面其作用仍不明确。技术难度和潜在并发症是在晚期尝试电视辅助胸腔镜手术（VATS）时犹豫不决的主要原因。
方法
我们前瞻性研究了 VATS 在 3 期脓胸中行胸廓切开术的安全性、可行性和有效性。
结果
在过去 7 年中，我们对 61 例尝试 VATS 的患者进行了研究，其中 45 例（73.77%）可以完成该手术。其中 4 例患儿因持续存在问题需要再次手术。16 例（26.23%）需要转为开胸手术。与需要转换的患者相比，行初次 VATS 胸廓切开术的患者术后住院时间明显缩短（p<0.0001）。
结论
即使在晚期脓胸中，胸腔镜也是一种安全、可行且有效的选择，应在具有足够专业知识和设备的中心提供。
证据等级
II 级。
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