Timely thoracoscopic decortication promotes the recovery of paediatric parapneumonic empyema

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• 作者：C. T. Lau ; C. H. Fung ; K. K. Y. Wong ; P. Tam
• 关键词：Empyema ; Thoracoscopic ; Decortication ; Recovery
• 刊名：Pediatric Surgery International
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：31
• 期：7
• 页码：665-670
• 全文大小：345 KB
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• 作者单位：C. T. Lau (1)
  C. H. Fung (1)
  K. K. Y. Wong (1)
  P. Tam (1)
  
  1. Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong, China
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Pediatrics
  Surgery
  Pediatric Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1437-9813

文摘

Introduction Parapneumonic empyema is one of the most commonly encountered yet difficult to manage paediatric thoracic conditions. Conservative treatment with chest tube drainage and fibrinolytic agents had been proposed but operative decortication remains the gold standard for refractory cases. Thoracoscopic decortication has been advocated in recent years due to its superiority in terms of post-operative pain, cosmesis and other long-term results. However, few studies investigated the effect of timing on peri-operative outcomes. This study aims to explore the benefits of early decortication. Methods Retrospective study of all patients who underwent thoracoscopic decortication between 1999 and 2013 at a tertiary referral centre was performed. Data were extracted from respective medical records. Patients-demographics, peri-operative outcomes, length of hospitalization and post-operative complications were analysed. Results A total of 28 patients were identified, 12 males and 16 females. Average age of patients was 4.5?years (range 12?months-4?years). Right-sided empyema was involved in 14 of the patients. Patients who underwent operation within 2?weeks from symptom onset (n?=?16) showed significant shorter post-operative hospital stay (mean 9.5 vs 20.4?days, p?=?0.003) and total hospitalization duration (mean 19.3 vs 38.8?days, p?<?0.001). Correlation study demonstrated a strong relation between delay in operation and prolonged hospitalization (r?=?0.63, p?=?0.001). The peri-operative and post-operative outcomes were similar. No major post-operative complication was encountered except one patient who required a second decortication for residual empyema. Conclusion Thoracoscopic decortication is a safe and feasible procedure for parapneumonic empyema. Timely surgery is recommended as it promotes early recovery and shorter hospitalization.