Spezzotto Giovanna, Boscarelli Alessandro, Giangreco Manuela, Ceschiutti Giulia, Codrich Daniela, Scarpa Maria-Grazia, Iaquinto Marianna, Olenik Damiana, Guida Edoardo, Schleef Jürgen
Faculty of Medicine and Surgery, University of Trieste, Trieste, Italy.
Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
Front Pediatr. 2022 Jun 27;10:945641. doi: 10.3389/fped.2022.945641. eCollection 2022.
The management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. The aim of this study was to investigate the risk of recurrence after non-surgical treatment vs. surgery, the difference in the length of stay (LOS) between various treatment options, and the role of computed tomography (CT) in the management of PSP.
We retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected.
Twenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9-18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Chest drain was used for large PSP (≥2 cm) if the patient was clinically unstable. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients. Chest drain insertion was associated with a longer LOS than observation alone (6.36 vs. 2.4 days), and surgery resulted in a longer LOS than other types of treatment ( = 0.001).
According to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion.
小儿原发性自发性气胸（PSP）的治疗仍存在争议。本研究的目的是调查非手术治疗与手术治疗后复发的风险、不同治疗方案之间住院时间（LOS）的差异以及计算机断层扫描（CT）在PSP治疗中的作用。
我们回顾性分析了2009年6月至2020年7月间因PSP发作入住我院小儿外科的患者。收集了包括入院时临床表现、诊断、治疗、并发症和住院时间在内的医疗记录。
本研究纳入23例患者（22例男性，1例女性）。中位年龄为15.65岁（范围9 - 18岁）。所有患者均进行了胸部X线检查，显示5例小面积（22%）和18例大面积（78%）PSP。如果患者临床不稳定，大面积PSP（≥2 cm）使用胸腔闭式引流。11例患者（48%）仅通过观察进行非手术治疗，复发率为18%；11例患者使用了胸腔闭式引流，复发率为36%；1例患者作为首选治疗选择进行了手术。6例患者（27%）在非手术治疗或胸腔闭式引流后出现复发。手术后，6例患者中有2例复发。胸腔闭式引流的住院时间比单纯观察长（6.36天对2.4天），手术导致的住院时间比其他类型的治疗长（P = 0.001）。
根据我们 的经验，小面积PSP或临床稳定的大面积PSP可仅通过观察进行保守治疗。对于有症状的大面积PSP、持续漏气和/或胸腔闭式引流后复发的儿童，应考虑手术治疗。
