Department of Thoracic Surgery, Combined Military Hospital, Multan, Pakistan.
Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi, Pakistan.
J Coll Physicians Surg Pak. 2020 Mar;30(3):309-312. doi: 10.29271/jcpsp.2020.03.309.
To compare the effectiveness of open thoracotomy and video assisted thoracic surgery (VATS) for empyema thoracis in paediatric population.
Observational study.
This observational study was conducted at Department of Thoracic Surgery, CMH, Lahore, from October 2013 to August 2018.
Medical record of children up to the age of 14 years who were operated for empyema thoracis was reviewed. Patients were divided into two groups: Open thoracotomy, and VATS; and compared for etiology, preoperative treatment, grade of empyema, procedure performed; histopathology and complications, e.g. post-thoracotomy neuralgia, surgical site infection, recurrence over 6 months.
A total of 61 paediatric patients were operated for empyema thoracis. Age ranged between 1 to 14 years (mean = 10.25 ±3.30 years). Most common etiology of empyema was tuberculosis in 24 (39.3%) cases, followed by pneumonia in 22 (36.1%). Surgical treatment consisted of open thoracotomy in 40 (65.5%) cases, while 21 (34.5%) underwent VATS. Postoperative X-ray was satisfactory in 38 (95%) cases undergoing open thoracotomy as compared to 21 (100%) cases undergoing VATS (p=value 0.29). There was no recurrence in either of the two groups over a follow-up period of six months. Overall complication rate was 32.5% (13 cases) in cases undergoing open thoracotomy, while 33.3% (7 cases) in VATS group (p=value 0.95). There was one (2.5%) mortality in open thoracotomy group, while no death occurred in VATS group.
Early surgical treatment, both open as well as VATS, gives satisfactory results in management of paediatric empyema. VATS is a safe alternative to open thoractomy with good success rate and less incidence of complications.
比较开胸手术和电视辅助胸腔镜手术（VATS）治疗小儿脓胸的效果。
观察性研究。
本观察性研究于 2013 年 10 月至 2018 年 8 月在拉合尔 CMH 胸外科进行。
回顾了年龄在 14 岁以下接受脓胸手术的儿童的病历。患者分为两组：开胸手术和 VATS；并比较病因、术前治疗、脓胸程度、手术方式、组织病理学和并发症，如开胸术后神经痛、手术部位感染、6 个月以上复发。
共有 61 例小儿脓胸患者接受手术。年龄在 1 至 14 岁之间（平均=10.25±3.30 岁）。脓胸最常见的病因是结核 24 例（39.3%），其次是肺炎 22 例（36.1%）。手术治疗包括开胸手术 40 例（65.5%），VATS 21 例（34.5%）。开胸手术后，38 例（95%）患者的术后 X 线满意，而 VATS 组 21 例（100%）患者满意（p 值=0.29）。两组在随访 6 个月内均无复发。开胸组总体并发症发生率为 32.5%（13 例），VATS 组为 33.3%（7 例）（p 值=0.95）。开胸组有 1 例（2.5%）死亡，VATS 组无死亡。
早期手术治疗，包括开胸手术和 VATS，对小儿脓胸的治疗效果满意。VATS 是一种安全的替代开胸手术的方法，成功率高，并发症发生率低。
