Soyer Tutku, Dariel Anne, Dingemann Jens, Martinez Leopoldo, Pini-Prato Alessio, Morini Francesco, De Coppi Paolo, Gorter Ramon, Doi Takashi, Antunovic Sanja Sindjic, Kakar Mohit, Hall Nigel J
Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Pediatric Surgery, AP-HM, Marseille, Provence-Alpes-Côte d'Azur, France.
Eur J Pediatr Surg. 2022 Oct;32(5):415-421. doi: 10.1055/s-0041-1739420. Epub 2021 Nov 25.
To evaluate the practice patterns of the European Pediatric Surgeons' Association (EUPSA) members regarding the management of primary spontaneous pneumothorax (PSP) in children.
An online survey was distributed to all members of EUPSA.
In total, 131 members from 44 countries participated in the survey. Interventional approach (78%) is the most common choice of treatment in the first episode, and most commonly, chest tube insertion (71%) is performed. In the case of a respiratory stable patient, 60% of the responders insert chest tubes if the pneumothorax is more than 2 cm. While 49% of surgeons prefer surgical intervention in the second episode, 42% still prefer chest tube insertion. Main indications for surgical treatment were the presence of bullae more than 2 cm (77%), and recurrent pneumothorax (76%). Eighty-four percent of surgeons prefer thoracoscopy and perform excision of bullae with safe margins (91%). To prevent recurrences, 54% of surgeons perform surgical pleurodesis with pleural abrasion (55%) and partial pleurectomy (22%). The responders who perform thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the surgeons performing open surgery ( < 0.05).
Most of the responders prefer chest tube insertion in the management of first episode of PSP and perform surgical treatment in the second episode in case of underlying bullae more than 2 cm and recurrent pneumothorax. The surgeons performing thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the responders performing open surgery. The development of evidence-based guidelines may help standardize care and improve outcomes in children with PSP.
评估欧洲小儿外科医生协会（EUPSA）成员对儿童原发性自发性气胸（PSP）的治疗模式。
向EUPSA的所有成员进行了一项在线调查。
共有来自44个国家的131名成员参与了调查。在首次发作时，介入治疗方法（78%）是最常见的治疗选择，最常进行的是胸腔闭式引流（71%）。对于呼吸稳定的患者，如果气胸超过2厘米，60%的受访者会插入胸腔闭式引流管。在第二次发作时，49%的外科医生倾向于手术干预，42%的医生仍然倾向于胸腔闭式引流。手术治疗的主要指征是存在直径超过2厘米的肺大疱（77%）和复发性气胸（76%）。84%的外科医生倾向于胸腔镜检查，并进行安全边缘的肺大疱切除术（91%）。为防止复发，54%的外科医生采用胸膜摩擦（55%）和部分胸膜切除术（22%）进行手术性胸膜固定术。与进行开放手术的外科医生相比，进行胸腔镜检查的受访者使用更多的手术性胸膜固定术，并且倾向于更短的胸腔闭式引流时间（<0.05）。
大多数受访者在PSP首次发作的治疗中倾向于胸腔闭式引流，在第二次发作且存在直径超过2厘米的潜在肺大疱和复发性气胸时进行手术治疗。与进行开放手术的受访者相比，进行胸腔镜检查的外科医生使用更多的手术性胸膜固定术，并且倾向于更短的胸腔闭式引流时间。基于证据的指南的制定可能有助于规范对PSP儿童的治疗并改善治疗效果。
