Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA.
Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA.
J Pediatr Surg. 2022 Dec;57(12):994-999. doi: 10.1016/j.jpedsurg.2022.05.001. Epub 2022 May 10.
The optimal timing of operative management in children with primary spontaneous pneumothorax (PSP) remains controversial. This study sought to determine early risk factors for failure of chest tube nonoperative management during the initial hospitalization in adolescents with PSP.
A retrospective review was conducted for children (aged ≤18 years) admitted to a single tertiary care referral center for their first presentation of a PSP managed with at least 48 h of chest tube decompression (CTD) alone. Patient outcomes and early risk factors for operative management were analyzed by multivariate regression.
Of the 39 patients who met inclusion criteria, 15 (38.5%) patients failed nonoperative treatment while 24 (61.5%) patients were managed with CTD therapy alone. Progression to thoracoscopic surgery was associated with longer CTD of 8 vs 3 days and hospital length of stay of 9 vs 4 days when compared to nonoperative management (p < 0.001, both). Air leak and increase in pneumothorax size at 24 h after CTD were independently associated with progression to surgery (p = 0.007, p = 0.002). Combined, these risk factors were associated with a significant increase in recurrence (OR 6.00, 95% CI 1.11-41.11, p = 0.048). There were no significant differences between PSP management strategies regarding cumulative radiation exposure or 2 year recurrence.
Air leak or increasing pneumothorax size within 24 h of CTD are highly correlated with failed nonoperative management during the initial hospitalization in pediatric patients with PSP. This data may be useful in the development of pediatric-specific treatment algorithms to optimally manage these patients.
Treatment study, Level III.
儿童原发性自发性气胸（PSP）的手术治疗时机仍存在争议。本研究旨在确定青少年 PSP 患者初次就诊时，接受至少 48 小时胸腔引流（CTD）单纯非手术治疗期间，发生 CTD 治疗失败的早期危险因素。
对在一家三级转诊中心接受治疗的初次出现 PSP 且接受至少 48 小时 CTD 单纯减压治疗的患儿（年龄≤18 岁）进行回顾性研究。通过多变量回归分析患者结局和手术治疗的早期危险因素。
符合纳入标准的 39 例患者中，15 例（38.5%）患者 CTD 治疗失败，24 例（61.5%）患者单纯接受 CTD 治疗。与非手术治疗相比，进展为胸腔镜手术的患者 CTD 时间为 8 天，而非 3 天（p<0.001），住院时间为 9 天，而非 4 天（p<0.001）。CTD 后 24 小时气胸漏气和气胸量增加与进展为手术独立相关（p=0.007，p=0.002）。这些危险因素联合起来与复发显著相关（OR 6.00，95%CI 1.11-41.11，p=0.048）。在 PSP 管理策略方面，累积辐射暴露或 2 年复发方面无显著差异。
CTD 后 24 小时内气胸漏气或气胸量增加与儿科 PSP 患者初次住院期间非手术治疗失败密切相关。该数据可能有助于制定儿科特异性治疗方案，从而优化此类患者的治疗。
治疗研究，III 级。
