Gebreselassie Hana Abebe, Tadesse Mekdelawit Mesfin, Woldeselassie Hanna Getachew
Department of Surgery, Pediatrics Surgery Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
Pediatric Health Med Ther. 2023 Mar 12;14:99-106. doi: 10.2147/PHMT.S398368. eCollection 2023.
Thoracotomy is indicated for several congenital and acquired disorders in children. It is among the surgical procedures which require a well-trained and dedicated surgical, anesthesia and critical care team which can be difficult to assemble in a low-income country setup. As the pattern and outcome of thoracotomy in children remained unreported from such setting, this study aims to shed light on this matter.
A descriptive cross-sectional review was conducted. Children who have undergone thoracotomy for non-cardiac pathologies were included in the study. Demographic and clinical data were collected by chart review. Frequencies and percentages were used to describe categorical variables while mean, median, standard deviation and interquartile range were calculated for continuous variables.
A total of 68 patients were operated on in the study period, out of which 44 (64.7%) were males. The mean ages of the children at the time of diagnosis and procedure were 4.05 ± 3.9 years and 4.14 ± 4.03 years, respectively. The most common indication for thoracotomy was pulmonary hydatid cyst (17; 25%) followed by congenital lobar emphysema (11; 16.2%). Muscle sparing posterolateral thoracotomy was the most common approach in 66 (97.1%) patients. The analgesic medications that were used in the post-operative period were paracetamol, diclofenac, ibuprofen, tramadol and morphine. Combined analgesics were administered in two-thirds of the patients while a single analgesic was used in the rest of the children. No regional blocks were administered post operatively as pediatric size catheters were not available. The morbidity and mortality rates were found to be 11.8% and 8.8%, respectively.
The most common indication for thoracotomy in this study was pulmonary hydatid cyst. The provision of post-thoracotomy analgesia in our institution is suboptimal as evidenced by no use of regional blocks and poor practice of administering multimodal analgesia. Thoracotomy was associated with fairly high morbidity and mortality.
开胸手术适用于儿童的多种先天性和后天性疾病。它属于需要训练有素且专注的外科、麻醉和重症监护团队的外科手术之一，而在低收入国家的环境中，组建这样的团队可能很困难。由于在这种环境下儿童开胸手术的模式和结果尚未见报道，本研究旨在阐明这一问题。
进行了一项描述性横断面回顾研究。纳入接受非心脏疾病开胸手术的儿童。通过病历审查收集人口统计学和临床数据。分类变量用频率和百分比描述，连续变量计算均值、中位数、标准差和四分位数间距。
研究期间共对68例患者进行了手术，其中44例（64.7%）为男性。儿童诊断时和手术时的平均年龄分别为4.05±3.9岁和4.14±4.03岁。开胸手术最常见的指征是肺包虫囊肿（17例；25%），其次是先天性大叶性肺气肿（11例；16.2%）。保留肌肉的后外侧开胸术是66例（97.1%）患者最常用的手术入路。术后使用的镇痛药物有对乙酰氨基酚、双氯芬酸、布洛芬、曲马多和吗啡。三分之二的患者使用了联合镇痛药，其余儿童使用单一镇痛药。由于没有适合儿童尺寸的导管，术后未进行区域阻滞。发现发病率和死亡率分别为11.8%和8.8%。
本研究中开胸手术最常见的指征是肺包虫囊肿。我们机构的开胸术后镇痛措施欠佳，表现为未使用区域阻滞且多模式镇痛的实施情况不佳。开胸手术的发病率和死亡率相当高。
