| Abstract | Cilj istraživanja: Pristup liječenju pneumotoraksa može biti konzervativan ili kirurški. Cilj ovog istraživanja bio je proučiti kliničke znakove i ishode liječenja djece liječene od pneumotoraksa u KBC–u Split.
Ispitanici i metode: Od 1. siječnja 2009. do 1. lipnja 2019. godine, 40 bolesnika u dobi do 18 godina uključeni su u ovu studiju. Bolesnici su podijeljeni u dvije skupine, non–VATS i VATS prema izabranoj metodi liječenja. Skupine smo usporedili obzirom na demografske i kliničke podatke te ishode liječenja (duljina hospitalizacije, učestalost poslijeoperacijskih komplikacija i reoperacija).
Rezultati: Od ukupno 40 bolesnika uključenih u našu studiju, 36 ih je liječeno od spontanog pneumotoraksa, a 4 od traumatskog. Bilo je 25 dječaka i 15 djevojčica, a prosječna dob iznosila je 16,5 godina. Prosječan BMI iznosio je 20 kg/m², a prosječna duljina hospitalizacije iznosila je 8 dana. Konzervativnom metodom liječeno je 8, torakalnom drenažom 28, a videotorakoskopijom 14 bolesnika. Indikacije za operaciju bile su perzistirajui pneumotoraks 8 (57%) i recidiv 6 (43%). Uočeno je da su operirani bolesnici imali značajno veći broj dana hospitalizacije od onih liječenih konzervativnom metodom ili torakalnom drenažom (P<0,001). Komorbiditeta je bilo više u skupini neoperiranih (P=0,008), a stopa komplikacije nije se značajno razlikovala među skupinama. Najviše je bilo lijevostranih, malih pneumotoraksa. U skupini bolesnika podvrgnutih VATS–u stopa recidiva bila je značajno manja nego u drugoj skupini (P=0,003). Od 14 operiranih bolesnika, 12 njih su intraoperacijski vizualizirane bule. Trajanje torakalne drenaže bilo je značajno dulje u skupini bolesnika sa recidivom (P<0,001).
Zaključci: VATS je uspješna, učinkovita i sigurna metoda liječenja spontanog
pneumotoraksa sa značajno nižom stopom recidiva u odnosu na torakalnu drenažu.
Pleurodeza je važan dodatak zahvatu VATS–a u liječenju bolesnika sa spontanim
pneumotoraksom, naročito u onih bolesnika kojima su intraoperacijski vizualizirane bule. |
| Abstract (english) | Objectives: Treatment of pneumothorax involves conservative treatment and surgery. The aim of this study was to evaluate the clinical signs and outcomes of treatment of pneumothorax in children managed in University Hospital of Split.
Patients and methods: From January 1st 2009 until June 1st 2019, 40 patients under the age of 18 who were treated because of pneumothorax were included into this retrospective study. Patients were divided into two groups, non–VATS and VATS, depending on the way they were treated. The groups were compared regarding demographic and clinical data and outcomes of treatment (the length of hospitalization, the frequency of postoperative complications and reoperations).
Results: Out of 40 patients included in this study 36 of them presented with spontaneous and 4 with traumatic pneumothorax (25 boys and 15 girls, mean age 16.5). Median BMI was 20 kg/m² and median duration of hospitalization was 8 days. Eight patients were treated by observation and 28 by chest tube insertion. In 14 patients with spontaneous pneumothorax video-assisted thoracic surgery was performed (indications were persistent pneumothorax in 8 (57%) and recurrent pneumothorax in 6 (43%) children). Patients who underwent surgery had significantly higher length of hospitalization than those who did not (P<0.001). On the other hand, comorbidity rates were significantly higher in the other group (P=0.008). The greatest number of pneumothoraces were left sided and small. Patients who underwent surgery had significantly lower rate of recurrence than those who did not (P<0.001). In 12 patients blebs were found intraoperatively. Duration of chest tube insertion was significantly longer in patients who experienced recurrent pneumothorax (P<0.001).
Conclusion: Video-assisted thoracic surgery is successfull, efficient and safe method of treatment for spontaneous pneumothorax, due to its significantly lower rate of recurrence in comparison with chest tube insertion. Pleurodesis is an important addition to this method, especially in patients who have blebs. |
