Poenaru D, Yazbeck S, Murphy S
Division of Pediatric General Surgery, Hôpital Sainte-Justine, Montreal, Quebec.
J Pediatr Surg. 1994 Sep;29(9):1183-5. doi: 10.1016/0022-3468(94)90795-1.
In the absence of pediatric data, spontaneous pneumothorax is managed according to adult guidelines. Fifty-eight patients with primary spontaneous pneumothorax (PSP) were treated in our center over the last 20 years. The median age was 16.7 years, and the male:female ratio was 1.9:1. A total of 102 PSP were treated; 63% were left-sided. The risk of recurrence was 51% after one PSP and 56% after two. There were four metachronous bilateral PSP. Nonoperative management included tube drainage in 57% of the cases (mean extent of PSP, 53%). Forty percent of patients were treated by supplemental oxygen and observation, without drainage (mean extent of PSP, 23%). Eleven patients were treated as outpatients, with Heimlich valves (mean extent of PSP, 64%). Fourteen patients (28%) underwent bullectomy, with or without pleurodesis. Thirteen of the surgically treated patient had experienced at least two episodes of PSP. Primary spontaneous pneumothorax in children has male predominance. The risk of recurrence after one episode is greater than that for adults. Operative management by bullectomy, with or without pleurodesis, carries little morbidity, has a high success rate, and is recommended after the first recurrence. It is safe to manage younger children conservatively because the chance of recurrence is lower; thoracotomy was not necessary in children under 9 years of age.
在缺乏儿科数据的情况下，自发性气胸按照成人指南进行处理。在过去20年里，我们中心共治疗了58例原发性自发性气胸（PSP）患者。中位年龄为16.7岁，男女比例为1.9:1。共治疗了102例PSP；63%为左侧。一次PSP后复发风险为51%，两次后为56%。有4例异时性双侧PSP。非手术治疗包括57%的病例采用胸腔闭式引流（PSP平均范围为53%）。40%的患者采用补充氧气和观察，未进行引流（PSP平均范围为23%）。11例患者作为门诊患者接受Heimlich瓣膜治疗（PSP平均范围为64%）。14例患者（28%）接受了肺大疱切除术，伴或不伴胸膜固定术。13例接受手术治疗的患者至少经历过两次PSP发作。儿童原发性自发性气胸以男性为主。一次发作后的复发风险高于成人。采用肺大疱切除术伴或不伴胸膜固定术的手术治疗并发症少，成功率高，首次复发后建议采用。对年幼儿童进行保守治疗是安全的，因为复发几率较低；9岁以下儿童无需开胸手术。
