Ng Glenn Yang Han, Nah Shireen Anne, Teoh Oon Hoe, Ong Lin Yin
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
General Paediatrics Service, KK Women's and Children's Hospital, Singapore, Singapore.
Pediatr Surg Int. 2020 Mar;36(3):383-389. doi: 10.1007/s00383-020-04619-x. Epub 2020 Jan 28.
The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes.
We reviewed children aged < 18 years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences.
63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9-15.9), and body-mass index was 17.9 kg/m (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1).
This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.
儿童原发性自发性气胸（PSP）复发的危险因素尚不明确。我们旨在确定可能的危险因素，并评估计算机断层扫描（CT）在预测未来发作方面的效用。
我们回顾了2008年至2017年在我院因PSP入院的18岁以下儿童，排除患有恶性肿瘤的儿童。提取基本人口统计学数据。收集的临床数据包括气胸的侧别、CT结果、治疗方案和复发情况。
共纳入63例患者，其中19例（30.2%）进行了CT扫描。共进行了41次手术。中位（四分位间距）年龄为15.4岁（14.9 - 15.9岁），体重指数为17.9kg/m²（15.8 - 19.3）。56例（88.9%）患者为男性。中位随访时间为19.8个月（11.6 - 35.9个月）。多因素逻辑回归分析确定首次发作时进行手术是随后对侧发生气胸的预测因素（比值比[95%置信区间]32.026[1.685 - 608.518]，p = 0.021）。未发现同侧复发的预测因素。CT扫描检测肺大疱的敏感性为76.5%，对气胸发生的预测较差（阳性预测值14.3%，似然比1.1）。
这是第一项表明首次就诊时进行手术似乎可预测对侧肺发生PSP的研究。CT在检测肺大疱和预测PSP发生方面似乎无效。
