Early video-assisted thoracic surgery in the management of empyema

被引:49
作者
Grewal, H
Jackson, RJ
Wagner, CW
Smith, SD
机构
[1] Univ Kansas, Sch Med, Wichita Clin, Dept Surg, Wichita, KS 67208 USA
[2] Univ Arkansas Med Sci, Little Rock, AR USA
[3] Arkansas Childrens Hosp, Dept Pediat Surg, Little Rock, AR 72202 USA
关键词
empyema; children; video-assisted thoracic surgery; VATS; thoracoscopy;
D O I
10.1542/peds.103.5.e63
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective. The appropriate timing, as well as the type of intervention, for the treatment of empyema in children is controversial. The advent of video-assisted thoracic surgery (VATS) has changed the way we treat these children. Therefore, we reviewed our experience with the early use of VATS in the treatment of empyema and formulated a treatment algorithm. Methods. We retrospectively reviewed medical records of all patients undergoing VATS for empyema at Arkansas Children's Hospital from December 1994 to February 1997. All patients were treated by the pediatric surgical service and had the diagnosis of empyema confirmed at surgery. Results are reported as means, unless otherwise noted. Results. Twenty-five children with empyema were treated with VATS during the review period. Their age was 48.3 months, and the duration of symptoms was 7.4 days. All the patients had parapneumonic empyemas and had received preoperative antibiotics for 10.1 days. Preoperative imaging included chest radiography in 25 (100%), ultrasonography in 20 (80%), and computed tomography in 10 (40%). All patients with documented loculated parapneumonic fluid collections underwent VATS within a mean of 2 days of hospitalization. Chest tubes were removed in 3.2 days, resulting in a postoperative length of stay of 4.9 days. Total length of stay was 7.3 days. One patient required conversion to minithoracotomy and required a transfusion. There were no other complications or deaths. Follow-up was available for 22 (88%) children, and there was resolution of symptoms in all children with no recurrences. Conclusions. Earlier intervention with VATS in the treatment of empyema in children is safe and may reduce hospital charges by shortening hospital stay. A treatment algorithm based on early use of VATS is also described.
引用
收藏
页码:art. no. / e63
页数:5
相关论文
共 31 条
[1]  
ADEYEMO AO, 1984, J NATL MED ASSOC, V76, P799
[2]  
BROOK I, 1990, PEDIATRICS, V85, P722
[3]   Empyema thoracis in children: A 26-year review of the Montreal Children's Hospital experience [J].
Chan, W ;
KeyserGauvin, E ;
Davis, GM ;
Nguyen, LT ;
Laberge, JM .
JOURNAL OF PEDIATRIC SURGERY, 1997, 32 (06) :870-872
[4]   Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions [J].
Chin, NK ;
Lim, TK .
CHEST, 1997, 111 (02) :275-279
[5]   PARAPNEUMONIC PLEURAL EFFUSION AND EMPYEMA IN CHILDREN - REVIEW OF A 19-YEAR EXPERIENCE, 1962-1980 [J].
CHONMAITREE, T ;
POWELL, KR .
CLINICAL PEDIATRICS, 1983, 22 (06) :414-419
[6]  
Davidoff AM, 1996, J LAPAROENDOSC SURG, V6, pS51
[7]   CT appearance of parapneumonic effusions in children: Findings are not specific for empyema [J].
Donnelly, LF ;
Klosterman, LA .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1997, 169 (01) :179-182
[8]   PLEURAL EMPYEMA IN CHILDREN - A NATIONWIDE RETROSPECTIVE STUDY [J].
FAJARDO, JE ;
CHANG, MJ .
SOUTHERN MEDICAL JOURNAL, 1987, 80 (05) :593-596
[9]   CURRENT INDICATIONS FOR DECORTICATION IN THE TREATMENT OF EMPYEMA IN CHILDREN [J].
FOGLIA, RP ;
RANDOLPH, J .
JOURNAL OF PEDIATRIC SURGERY, 1987, 22 (01) :28-33
[10]   INCIDENCE, MANAGEMENT, AND OUTCOME OF CHILDHOOD EMPYEMA - A PROSPECTIVE-STUDY OF CHILDREN IN CAMBODIAN REFUGEE CAMPS [J].
FONTANET, AL ;
MCCAULEY, RGK ;
COYETTE, Y ;
LARCHIVER, F ;
BENNISH, ML .
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 1993, 49 (06) :789-798