Pediatric Spontaneous Pneumothorax: Does Initial Treatment Affect Outcomes?
Pediatric Spontaneous Pneumothorax: Does Initial Treatment Affect Outcomes?
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DOI：
10.1016/j.jss.2020.10.008
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发表时间：
2021-02-17
影响因子：
2.2
通讯作者：
Williams, Regan F.
中科院分区：
文献类型：
--
作者：
Lewit, Ruth A.;Tutor, Austin;Williams, Regan F.
背景资料：原发性自发性气胸（PSP）通常发生在青少年中，最常见于男性，复发率在20%至60%之间。长期以来，外科治疗在预防复发方面的作用一直存在争议，目前还没有就护理指南达成共识。本研究的目的是检查治疗类型对儿童PSP复发率的影响。方法：这是一项单机构、机构审查委员会批准的回顾性分析，对2009年至2017年期间首次诊断为PSP的1至18岁患者进行分析。收集了患者的人口统计学资料、住院过程和2年期间的结局。患者分为非手术（仅氧疗）管理，胸管放置，和手术治疗。主要结果是复发率。结果：64例诊断为PSP的患者符合纳入标准。平均年龄为15.5岁，48例（75%）患者为男性。21例（33%）患者接受非手术治疗，24例（37.5%）患者接受电视胸腔镜手术或开胸手术治疗，19例（30%）患者仅接受胸管或猪尾放置。15名患者（23.4%）在2年内复发：6名患者（29%）来自非手术治疗组，4名（21%）仅接受胸管治疗，5名（21%）接受电视辅助胸腔镜手术或开胸手术。治疗组间复发率无统计学显著差异。不同治疗类型的气胸大小不同;较大的气胸更可能接受手术干预（P = 0.0003）。多因素Logistic回归分析结果显示，气胸面积越小，复发率越高（P = 0.046）。结论：青少年PSP的复发率在2年随访后为23.4%。较小的气胸与较高的复发率相关，但治疗类型对复发率无显著影响。(C)2020爱思唯尔公司All rights reserved.
Background: Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents, most commonly in males, and has recurrence rates between 20% and 60%. Surgical therapy has long been debated regarding its role in preventing recurrence, with no current consensus on guidelines for care. The purpose of this study is to examine the effect of treatment type on recurrence rates in pediatric PSP.Methods: This is a single-institution, institutional review board-approved retrospective analysis of patients aged 1 to 18 diagnosed with their first occurrence of PSP between 2009 and 2017. Patient demographics, hospital course, and outcomes over a 2-y period were collected. Patients were divided into nonoperative (oxygen therapy only) management, chest tube placement, and surgical management. The primary outcome was the recurrence rate.Results: Sixty-four patients diagnosed with PSP met inclusive criteria. The mean age was 15.5, and 48 (75%) of patients were men. Twenty-one patients (33%) underwent nonoperative treatment, 24 patients (37.5%) underwent operative treatment with video-assisted thoracoscopic surgery or open thoracotomy, and 19 patients (30%) underwent chest tube or pigtail placement alone. Fifteen patients (23.4%) experienced a recurrence within 2 y: 6 patients (29%) from the nonoperative treatment group, 4 (21%) who were treated with the chest tube only, and 5 (21%) who underwent video-assisted thoracoscopic surgery or open thoracotomy. No statistically significant difference in recurrence rates was found between treatment groups. Pneumothorax size was found to differ between treatment type; larger pneumothoraces were more likely to undergo surgical intervention (P = 0.0003). Smaller pneumothoraces were associated with higher rates of recurrence on multivariate logistic regression analysis (P = 0.046).Conclusions: Recurrence of PSP in adolescents was found to be 23.4% after 2-y follow-up. Smaller-sized pneumothoraces were associated with higher rates of recurrence, but treatment type did not significantly affect recurrence rates. (C) 2020 Elsevier Inc. All rights reserved.