Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je proučiti kliničke znakove i ishode rane dekortikacije videoasistiranim torakoskopskim pristupom u liječenju empijema pleure.
Ispitanici i metode: U razdoblju od 1.siječnja 2009. do 1. lipnja 2019.u 21 bolesnika mlađeg od 18 godina učinjena je videoasistirana torakoskopija zbog empijema pleure. Bolesnike smo promatrali s obzirom na demografske, laboratorijske i kliničke podatke, te ishode liječenja (duljina hospitalizacije, trajanje poslijeoperacijske drenaže, učestalost poslijeoperacijskih komplikacija i recidiva).
Rezultati: Od ukupno 59 bolesnika liječenih zbog empijema pleure, njih 21 operirano je videoasistiranim torakoskopskim pristupom. U studiju je uključeno 10 (47,6%) dječaka i 11 (52,4%) djevojčica, s medijanom dobi od 5,0 godina (IQR 2,8; 6,0). Najzastupljeniji simptomi bili su vrućica (100%), plitko disanje (76,2%) i kašalj (52,4%). U najvećeg broja bolesnika učinjena je RTG snimka pluća (100%) i ultrazvučni pregled prsišta (90,5%) u svrhu prijeoperacijske obrade. Od ukupnog broja operirane djece njih 11 (52,4%) imalo je empijem pleure s lijeve strane, njih 9 (42,9%) s desne, a obostrano lokaliziran empijem imalo je jedno dijete (4,8%). Empijem je intraoperacijski u 2 (9,5%) bolesnika klasificiran kao Stadij I; u 4 (19%) kao Stadij II i u 15 (71,5%) kao Stadij III. Medijan duljine trajanja simptoma iznosio je 10 dana (IQR 7; 16,3), dok je medijan duljine hospitalizacije iznosio 9 dana (IQR 7; 11,3). Medijan trajanja poslijeoperacijske drenaže iznosio je 5 dana (IQR 4; 7), a medijan trajanja operacijskog zahvata iznosio je 60 (IQR 50; 90) minuta. Ukupno su zabilježene dvije (9,5%) poslijeoperacijske komplikacije (pneumotoraks i supkutani emfizem), jedan neuspjeh (4,8%), a konverzije na otvoreni pristup nije bilo.
Zaključak: Rana dekortikacija videotorakoskopskim pristupom je uspješna, učinkovita i lako izvodljiva metoda u liječenju empijema pleure u dječjoj dobi, koja značajno ubrzava oporavak bolesnika i skraćuje vrijeme provedeno u bolnici. |
Abstract (english) | Aim: The aim of this study was to observe the clinical signs and outcomes of early decortication during treatment of pleural empyema using video-assisted thoracoscopy.
Subjects and methods: The study observed 21 patients under 18 years of age on whom a video-assisted thoracoscopy was performed to treat pleural empyema in the time period between the January 1st2009 and June 1st 2019. The chosen patients were observed based on demographic, laboratory and clinical data, as well as treatment outcomes (length of hospital stay, duration of postoperative drainage, frequency of postoperative complications and recurrences).
Results: Out of a total of 59 patients treated for pleural empyema, 21 were operated using video-assisted thoracoscopy. The study included 10 (47.6%) boys and 11 (5.4%) girls with a median age of 5.0 (IQR 2.8; 6.0). The most frequent symptoms were fever (100%), shallow respiration (76.2%), and cough (52.4%). The largest number of patients had a chest X-ray (100%) and ultrasound examination of the chest (90.5%) performed as a part of pre-operative assessment. Out of the total number of children operated, 11 (52.4%) of them had a left-sided pleural empyema, 9 (42.4%) right-sided, and only one child (4.8%) had a bilateral empyema. The empyema was intraoperatively classified as Stage I in 2 patients (9.5%), Stage II in 4 patients (19%), and Stage III in 15 patients (71.5%). The median duration of symptoms was 10 days (IQR 7; 16.3) while median postoperative length of hospital stay was 9 days (IQR 7; 11.3). The median duration of postoperative drainage was 5 days (IQR 4; 7), and the median duration of surgery was 60 minutes (IQR 50; 90). There were in total 2 (9.5%) postoperative complications (pneumothorax and subcutaneous emphysema), 1 failed procedure (4.8%), while there was no procedure where a conversion to open surgery was necessary.
Conclusion: Early decortication using a videothoracoscopic approach is a successful, effective, and easily performed surgical method in the treatment of pediatric pleural empyema, as well as a method that significantly improves patient recovery time and shortens the hospital stay. |