VATS for First Episode of Primary Spontaneous Pneumothorax in Pediatric Patients: Clinical Experience in a Single Medical Center

影像輔助式胸腔手術在兒童原發性自發性氣胸第一次發作時的使用：單一醫學中心的臨床經驗

陳德忠(Te-Zhung Chen) ； 周佳滿(Chia-Man Chou) ； 陳厚全(Hou-Chuan Chen)

《Mid-Taiwan Journal of Medicine》 13卷2期 (2008/06) Pp. 89-94

https://doi.org/10.6558/MTJM.2008.13(2).4

摘要

Background/Purpose. To investigate the clinical strategy, management, outcome and indications of early VATS intervention during the first episode of primary spontaneous pneumothorax (PSP) in children aged less than 18 years.
Methods. Retrospective chart review of patients with a diagnosis of primary spontaneous pneumothorax from January 1, 2002 to July 31, 2007 in the Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital.
Results. There were 11 episodes of PSP in 9 patients during the study period. The patients ranged in age from 12 to 17 years. The mean age was 15.5±2.6 years. All patients were boys. The mean height was 61.59 cm, the mean weight percentile was 35.64 and the mean BMI was 18.6. Pneumothorax occurred on the left side 63.6% of the time. The initial presenting symptoms were chest pain in 8 (73%) and dyspnea in 4 (35.64%) patients. All 9 patients underwent surgical procedures (VATS with blebectomy or abrasive pleurodesis) for the first episode. Blebs or bullae were found in specimens from all patients. No recurrence was noted on the same side after thoracoscopic therapy at the most recent follow-up (mean, 9.1 mo).
Conclusion. VATS intervention for the first episode of PSP should be considered in pediatric patients who present with severe symptoms and signs, large (＞30%) pneumothorax, synchronous bilateral pneumothorax, progressively enlarging pneumothorax under conservative treatment, persistent air leakage (longer than 4 days) under tube thoracostomy drainage, subpleural blebs or bullae demonstrated on HRCT.

關鍵字

氣囊切除術 ； 兒童 ； 肋膜沾黏術 ； 原發性自發性氣胸

並列摘要

Background/Purpose. To investigate the clinical strategy, management, outcome and indications of early VATS intervention during the first episode of primary spontaneous pneumothorax (PSP) in children aged less than 18 years.
Methods. Retrospective chart review of patients with a diagnosis of primary spontaneous pneumothorax from January 1, 2002 to July 31, 2007 in the Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital.
Results. There were 11 episodes of PSP in 9 patients during the study period. The patients ranged in age from 12 to 17 years. The mean age was 15.5±2.6 years. All patients were boys. The mean height was 61.59 cm, the mean weight percentile was 35.64 and the mean BMI was 18.6. Pneumothorax occurred on the left side 63.6% of the time. The initial presenting symptoms were chest pain in 8 (73%) and dyspnea in 4 (35.64%) patients. All 9 patients underwent surgical procedures (VATS with blebectomy or abrasive pleurodesis) for the first episode. Blebs or bullae were found in specimens from all patients. No recurrence was noted on the same side after thoracoscopic therapy at the most recent follow-up (mean, 9.1 mo).
Conclusion. VATS intervention for the first episode of PSP should be considered in pediatric patients who present with severe symptoms and signs, large (＞30%) pneumothorax, synchronous bilateral pneumothorax, progressively enlarging pneumothorax under conservative treatment, persistent air leakage (longer than 4 days) under tube thoracostomy drainage, subpleural blebs or bullae demonstrated on HRCT.

並列關鍵字

blebectomy ； children ； pleurodesis ； primary spontaneous pneumothorax