兒童之原發性自發性氣胸

Primary Spontaneous Pneumothorax in Children

蕭輔國(Fu-Kuo Hsiao) ； 黃淑娟(Shu-Chuan Huang) ； 邱漢堯(Han-Yao Chiu) ； 曹龍彥(Lon-Yen Tsao) ； 林清淵(Ching-Yuang Lin)

《中華民國兒童胸腔醫學會雜誌》 5卷2期 (2006/07) Pp. 60-67

https://doi.org/10.6322/JPRD.200607_5(2).0002

摘要

兒童氣胸多數是由於外傷、醫源性或肺實質病變引起。原發性自發性氣胸在兒童非常少見，且大多發生在十幾歲男生。為了瞭解原發性自發性氣胸發生在兒童的臨床特點及造成的原因，本研究收集從1994至2003年，年齡由一個月至十八歲，因自發性氣胸從彰化某醫學中心出院的個案。並且將外傷、肺炎、醫源性或其他原因引起的自發性氣胸排除。共收樣本個案84位，回溯性研究探討徊案住院期間之臨床表徵及治療。所收樣本特徵：男性72人、女性12人。年齡分佈於14至18歲。研究結果發現：胸痛發生於96.4%的病人、呼吸困難56%、咳嗽14.3%、呼吸急促8.3%、胸悶7.1%。96.4%的病人呼吸音降低；3.6%的病人呼吸音消失。於住院期間所接受之治療方式包括：給氣治療(4.8%)、胸管引流(57.1%)和手術治療(38.1%)。31位病人(36.9%)胸管引流治療失敗改採手術治療。樣本中有63位採手術治療的患者中有61位發現有囊泡，囊泡大部分位在肺尖和上葉。樣本中有21位患者有氣胸復發，其中吸煙者(36.7%, N=9)較不吸煙者(22.7%, N=75)有較高之再發率；第一次原發性自發性氣胸發作和第二次發作平均間隔11.8個月；第二次發作和第三次發作間隔縮短為7.4個月。雖本研究樣本中未發現14歲以下兒童之原發性自發性氣胸案例，但仍建議兒童有胸痛、呼吸困難的症狀則要考慮自發性氣胸的可能性，且為避免自發性氣胸之再發率，建議吸煙者應進行戒煙。

關鍵字

自發性氣胸 ； 胸腔鏡手術 ； 囊泡

並列摘要

Most pneumothorax in children are the result of trauma, iatrogenic and parenchymal pulmonary conditions. Primary spontaneous pneumothorax (PSP) is rare in children and most occurred in adolescent males. To investigate the clinical features and predisposing factors of pediatric PSP at the Changhau Christian Hospital. From 1994 to 2003, we collected patients discharged from Changhau Christrian Hospital of age between one month to eighteen years of whom were diagnosed spontaneous pneumothorax. The diagnosis was made by plain chest radiographs. Patients with pneumothorax following trauma, necrotizing pneumonia, iatrogenic and other underlying causes were excluded. Eighty-four patients (72 males, 12 females) were included of whom 96.4% had chest pain; 7.1% had chest tightness; 56% had dyspnea; 8.3% had shortness of breath and 14.3% had cough. 96.4% had decreased breathing sound and 3.6% had absent breathing sound. Therapeutic choices included observation with oxygen supplement (4.8%), closed chest tube drainage (57.1%), and surgical procedure (38.1%) (Video-assisted thoracoscopy (VATS) or limited thoracotomy). Thirty-one patients (36.9%) were managed by closed drainage had persistent leakage and surgical procedure was performed. Sixty-three patients underwent surgical procedures (62 VATS, 1 limited thoracotomy) and bullae or blebs were found in 61 patients. Only 2 patients had no bullae or blebs were found. Bullae or blebs occurred mostly in apex and upper lobe. Twenty-one patients suffered from recurrent pneumothorax. Smokers (36.7%, N=9) had higher recurrent rate than non-smokers (22.7%, N=75). We found that patient had PSP with a history of smoking has higher recurrent rate of PSP, smoking-cessation program in these group is indicated especially.

並列關鍵字

spontaneous pneumothroax ； Video-assisted thoracoscopy ； bullae