Genç A, Ozcan C, Erdener A, Mutaf O
Department of Pediatric Surgery, Ege University, Faculty of Medicine, Izmir, Turkey.
J Cardiovasc Surg (Torino). 1998 Dec;39(6):849-51.
The efficacy of tube thoracostomies inserted at the sixth intercostal space at midaxillary line was evaluated retrospectively in children.
Ninety-seven children with pneumothorax, treated by tube thoracostomy were taken into the study. There were 67 male and 30 female patients with a mean age of 6.5 years (range 1 days to 15 years)
Pneumothorax was located at the right side in 50 (51.5%), and at the left in 38 (39.1%) of the cases. Bilateral pneumothorax was found in 9 additional patients (9.2%). All patients were treated with tube thoracostomy placed in the pleural cavity at the sixth intercostal space at the mid-axillary line. Postoperative course was uneventful and no complication was encountered at any of the patients.
On the basis of these data we suggest that all thoracostomy tubes should be inserted on the sixth intercostal space where both air and the accumulating fluid can be reached. The insertion of the thoracostomy tube at the second intercostal space must be avoided since it carries a high risk of subclavian vein injury in small children, and also a secondary tube is frequently required to drain the accompanying intrapleural fluid.
回顾性评估在儿童腋中线第六肋间插入胸腔闭式引流管的疗效。
97例接受胸腔闭式引流术治疗气胸的儿童纳入研究。其中男性67例，女性30例，平均年龄6.5岁（范围1天至15岁）。
50例（51.5%）气胸位于右侧，38例（39.1%）位于左侧。另外9例（9.2%）为双侧气胸。所有患者均在腋中线第六肋间胸腔内置入胸腔闭式引流管。术后病程平稳，所有患者均未出现并发症。
基于这些数据，我们建议所有胸腔闭式引流管均应插入第六肋间，在此处既能引出气体又能引出积聚的液体。必须避免在第二肋间插入胸腔闭式引流管，因为这在小儿中有较高的锁骨下静脉损伤风险，而且往往还需要一根辅助引流管来引流伴发的胸腔内液体。
