Miscia Maria Enrica, Castellano Maria, Chiarini Stella, Lauriti Giuseppe, Casaccia Marco, Lelli Chiesa Pierluigi, Lisi Gabriele
Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
Thoracic Surgery Unit, "Santo Spirito" Hospital of Pescara.
Pediatr Med Chir. 2023 Mar 15;45(1). doi: 10.4081/pmc.2023.303.
Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of "large" pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 "large" pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.
小儿原发性自发性气胸（PSP）的治疗存在争议，且基于成人治疗指南。治疗策略包括：观察、针吸、胸腔引流或手术。我们旨在评估：i）儿科与成人科室在PSP治疗上的差异；ii）每种治疗选择相关的复发风险；iii）“大量”气胸（即胸部X线片上肺尖处>3cm）的治疗；iv）CT扫描在指导治疗中的作用。我们回顾了10年期间（2011年至2020年）在儿科外科病房（PSU）和成人胸外科病房（TSU）治疗的所有PSP病例。我们共纳入42例PSP：42例中有30例为首次发作，12例为复发。在30例首次发作病例中，15例在PSU治疗，15例在TSU治疗。观察在PSU患者中显著更为常见（9/15，60%），而在TSU病例中为（1/15，6.7%；p=0.005）。PSU中胸腔引流的放置率低于TSU（3/15，20%）对（12/15，80%；p=0.002）。与胸腔引流相比，观察与较低的复发风险相关（0/10，0%）对（7/15，46.7%；p=0.01）。42例中20例“大量”气胸的治疗情况为：4/20（20%）观察，10/20（50%）胸腔引流，2/20（10%）针吸，4/20（20%）手术。29例PSP中有23例（79.3%）在首次发作后接受了CT扫描。17/23例患者检测到肺大疱，其中5/17（29.4%）有7次复发。PSU治疗的PSP患者更有可能接受临床观察。TSU治疗的患者大多接受胸腔引流。观察似乎是临床稳定的PSP的有效选择，中期随访复发风险较低。CT扫描似乎无法检测出复发风险较高的患者。
