常规胸部 X 光检查在拔除猪尾胸管后很少改变儿童的治疗方案。
Routine chest X-rays after pigtail chest tube removal rarely change management in children.
机构信息
Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA.
Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, CA, USA.
出版信息
Pediatr Surg Int. 2021 Oct;37(10):1447-1451. doi: 10.1007/s00383-021-04951-w. Epub 2021 Jun 25.
BACKGROUND
The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management.
METHODS
Patients < 18 years old with pigtail chest tubes placed 2014-2019 at a tertiary children's hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion.
RESULTS
111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax.
CONCLUSIONS
Post-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.
背景
大口径胸腔引流管拔除后是否需要行胸部 X 线检查（CXR）一直存在争议；然而，对于拔除小口径猪尾胸腔引流管后是否需要行 CXR 检查，目前尚不清楚。我们假设，在拔除猪尾胸腔引流管后获得的 CXR 不会改变治疗方案。
方法
回顾 2014 年至 2019 年在一家三级儿童医院接受猪尾胸腔引流管置入的年龄<18 岁的患者。排除标准为年龄<1 个月、死亡或带管转移、或猪尾胸腔引流管更换为大口径胸腔引流管。主要结局为胸腔引流管重新插入。
结果
111 例患者共进行了 123 例猪尾胸腔引流管插入术；12 例患者行双侧胸腔引流管插入术。中位年龄为 5.8 岁。适应证为气胸（n=53）、胸腔积液（n=54）、乳糜胸（n=6）、脓胸（n=5）和血胸（n=3）。在 123 例中，有 121 例（98.4%）在拔管后进行了 CXR 检查。没有进行拔管后 CXR 检查的两名儿童均无需重新插入胸腔引流管。两名患者需要重新插入胸腔引流管（1.6%），均因乳糜胸再次积聚。
结论
在拔除猪尾胸腔引流管后，几乎普遍会进行拔管后 CXR 检查，但很少会改变治疗方案。医生应根据症状和潜在诊断来获得拔管后影像学检查，对于乳糜胸患儿，应更怀疑其复发的可能性。
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