Şahin Ceyhan, Ayyıldız Hayriye Nihan Karaman, Mirapoğlu Semih, Güvenç Fatma Tuğba, Akis Yıldız Zeliha, Arpacik Mehmet, Kaymakçı Aytekin, Ilce Zekeriya
Pediatric Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR.
Cureus. 2023 Jul 28;15(7):e42624. doi: 10.7759/cureus.42624. eCollection 2023 Jul.
This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature.
The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study.
The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months.
Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.
本研究旨在回顾我们所治疗的原发性自发性气胸（PSP）患者，并根据文献探讨PSP治疗管理及电视辅助胸腔镜手术（VATS）应用方面的结果。
本研究为回顾性设计，于2015年1月1日至2021年5月1日在一所三级转诊大学医院进行。纳入诊断为气胸（PTX）的18岁以下患者。从临床特征、人口统计学数据、影像资料结果、所施行的操作以及在医院的疾病进程等方面分析病历。放射学影像（直接后前位胸片（PACXR）或胸部计算机断层扫描（TCT））无PTX证据、随访病历不完整、有创伤史以及新生儿PTX患者被排除在研究之外。
本研究共纳入69例患者的98例PTX病例，其中男性61例（88.4%），女性8例（11.6%）。患者年龄在13至17岁之间，平均为16.59±0.95岁。48例（49%）PTX病例采用胸腔闭式引流术治疗，19例（19.4%）采用医学随访（非手术治疗），31例（31.6%）采用VATS治疗。共对28例患者进行了31例VATS手术。VATS术后随访期为3至78个月，平均为31.5±20.3个月，中位数为28个月。
我们的回顾性研究表明，对于出现胸痛和呼吸窘迫且PACXR检测到PSP的患者，TCT扫描未提供额外益处。根据我们的研究结果，认为随着PACXR检测到的PTX百分比增加，接受侵入性操作和手术干预的可能性增加。对于PSP患者，如果在决定医学随访后平均60小时后PTX未开始减少且肺扩张未增加，以及随访中PTX呈进行性发展，则可能需要进行胸腔闭式引流术。当胸腔闭式引流术后平均18小时后肺扩张未增加、PTX进展、尽管肺扩张增加但漏气持续超过10天以及发生复发性PTX时，可对PSP患者施行VATS。
