Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why?

被引:9
作者
Yeung, Fanny [1 ]
Chung, Patrick H. Y. [1 ]
Hung, Esther L. Y. [1 ]
Yuen, Chi Sum [1 ]
Tam, Paul K. H. [1 ]
Wong, Kenneth K. Y. [1 ]
机构
[1] Univ Hong Kong, Med Ctr, Queen Mary Hosp, Div Paediat Surg,Dept Surg, 102 Pokfulam Rd, Hong Kong, Hong Kong, Peoples R China
来源
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES | 2017年 / 27卷 / 08期
关键词
pediatric surgery; thoracic; perioperative complications; ASSISTED THORACIC-SURGERY; INVASIVE TREATMENT; MANAGEMENT; CHILDREN; TOMOGRAPHY; GUIDELINE; RESECTION; BLEBS; CT;
D O I
10.1089/lap.2016.0163
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence. Materials and Methods: We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed. Results: A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007). Conclusion: Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.
引用
收藏
页码:841 / 844
页数:4
相关论文
共 30 条
  • [1] Familial spontaneous pneumothorax
    Bagchi, I
    Nycyk, JA
    [J]. ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 2002, 87 (01): : F70 - F70
  • [2] Management of spontaneous pneumothorax - An American College of Chest Physicians Delphi Consensus Statement
    Baumann, MH
    Strange, C
    Heffner, JE
    Light, R
    Kirby, TJ
    Klein, J
    Luketich, JD
    Panacek, EA
    Sahn, SA
    [J]. CHEST, 2001, 119 (02) : 590 - 602
  • [3] Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique?
    Bialas, Ryan C.
    Weiner, Timothy M.
    Phillips, J. Duncan
    [J]. JOURNAL OF PEDIATRIC SURGERY, 2008, 43 (12) : 2151 - 2155
  • [4] NON-INVASIVE TREATMENT OF PNEUMOTHORAX WITH OXYGEN INHALATION
    CHADHA, TS
    COHN, MA
    [J]. RESPIRATION, 1983, 44 (02) : 147 - 152
  • [5] Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients
    Chiu, Chih-Yung
    Chen, Tzu-Ping
    Wang, Chia-Jung
    Tsai, Ming-Han
    Wong, Kin-Sun
    [J]. EUROPEAN JOURNAL OF PEDIATRICS, 2014, 173 (11) : 1483 - 1490
  • [6] Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children
    Choi, Si Young
    Kim, Yong Hwan
    Jo, Keon Hyon
    Kim, Chi Kyung
    Park, Jae Kil
    Cho, Deog Gon
    Jeong, Seong Cheol
    Jeon, Hyun Woo
    Park, Chan Beom
    [J]. PEDIATRIC SURGERY INTERNATIONAL, 2013, 29 (05) : 505 - 509
  • [7] Thoracoscopic bullectomy for primary spontaneous pneumothorax in pediatric patients
    Chung, Patrick H. Y.
    Wong, Kenneth K. Y.
    Lan, Lawrence C. L.
    Tam, Paul K. H.
    [J]. PEDIATRIC SURGERY INTERNATIONAL, 2009, 25 (09) : 763 - 766
  • [8] QUANTIFICATION OF PNEUMOTHORAX SIZE ON CHEST RADIOGRAPHS USING INTERPLEURAL DISTANCES - REGRESSION-ANALYSIS BASED ON VOLUME MEASUREMENTS FROM HELICAL CT
    COLLINS, CD
    LOPEZ, A
    MATHIE, A
    WOOD, V
    JACKSON, JE
    RODDIE, ME
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 1995, 165 (05) : 1127 - 1130
  • [9] RESECTION OF PULMONARY BLEBS AND PLEURODESIS FOR SPONTANEOUS PNEUMOTHORAX
    DONAHUE, DM
    WRIGHT, CD
    VIALE, G
    MATHISEN, DJ
    [J]. CHEST, 1993, 104 (06) : 1767 - 1769
  • [10] Is Spontaneous Pneumothorax Really a Pediatric Problem? A National Perspective
    Dotson, Kurtis
    Timm, Nathan
    Gittelman, Mike
    [J]. PEDIATRIC EMERGENCY CARE, 2012, 28 (04) : 340 - 344