thoracoscopic treatment of primary spontaneous pneumothorax in children maria marciniak...
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Thoracoscopic treatment of primary spontaneous
pneumothorax in children
Maria MarciniakStudents' Scientific Society at the Department of Surgery and
Oncology of Medical University in LodzTutor: J. Jablonski, MD
Head of Pediatric Surgery and Oncology Clinic: Prof. E. Andrzejewska, MD, PhD
PneumothoraxThe accumulation of free air within the
pleural cavity with subsequent collapse of the lung
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PNEUMOTHORAX
Traumatic Idiopathic Iatrogenic
SecondaryPrimary
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Primary spontaneous pneumothorax
Subpleural emphysema bubbles burst
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Guimaraes CVA i wsp. CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls. Pediatr Radiol. 2007
Guimaraes CVA i wsp. CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls. Pediatr Radiol. 2007
The formation of subpleural emphysema bubbles
5 z 21Guimaraes CVA i wsp. CT findings for blebs and bullae in…
Treatment of PSP
Conservative
SurgicalDrainage passive / active
Puncture and aspiration
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SURGICAL TREATMENT
Thoracotomy Thoracoscopy
Excision of pulmonary emphysema bubbles
Pleurodesis
Pleurectomy
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THORACOSCOPY
Effective diagnostic and therapeutic tool
Is considered by many authors as „gold standard" in the treatment of
PSP
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PSP treatment in children
None of the guidelines for the PSP differentiate pediatric patients
A small number of reports on the treatment of PSP in children (1985-2010 r. - 23 reports)
There is no optimal algorithm
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40-61% 40-61% of children have recurrent pneumothorax after drainage of the first
episode of PSP
Small amount of relapses
Shortening the duration of hospitalization
Lower costs
EarlierEarlier thoracoscopythoracoscopy
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Pneumothorax in children
Lack of lung expansion after drainage
Recurrence of pneumothorax on the opposite side
Air leak > 5-7 days
Simultaneous bilateral pneumothorax
The first episode of pneumothorax
The second episode of pneumothorax on the same side
Drainage of the pleural cavity
Thoracoscopy
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Thoracoscopic treatment of spontaneous pneumothorax
in the Department of Pediatric Surgery and Oncology
• 3 patients (4 operations) 2007-2010
• all patients showed the presence of emphysema bubbles at the top of the lungs
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Chest pain, shortness of breath n = 3Radiological examination
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Computed tomography n = 2
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Boy 16 year old• Episode I of pneumothorax on the left side –
successful drainage of pleural cavity, discharged after 11 days of treatment
• Episode II (after 4 weeks) - drainage of pleural cavity
• Episode III (after 6 weeks)• CT - emphysema bubble at the top of the
lung• thoracoscopy in the 3rd day of
hospitalization, discharged after 10 days of treatment
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Boy 15 year old• Episode I - spontaneous pneumothorax on
the left side• indications - the persistent air leak after the
insertion of pleural drainage• thoracoscopy in 9th day of treatment• discharged at 4th day after surgery• Episode II - pneumothorax on the right side 8
weeks after recovery of the left pneumothorax
• thoracoscopy with resection of the pulmonary emphysema at the top of the right lungdischarged after 3 days
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Girl 17 year old
• pneumothorax on the right side - pleural drainage
• indications - persistent air leak after a period of improvement
• thoracoscopy in the 20th day of treatment - resection of pulmonary emphysema bubbles located at the top of the lung
• discharged after 7 days
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Summary
• in all patients treated with thoracoscopy we obtained a good result
• there were no complications
• there were no recurrences - the period of observation 6 - 12 months
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MOVIE
Conclusion
1. The high relapse rate in children treated with drainage of the pleural cavity due to the PSP supports the eligibility of these patients
prior to thoracoscopy
2. Thoracoscopy in children with PSP is an effective and safe therapeutic procedure
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Epidemiology of PSP - Children
The average age 13 years (13-17)
Incidence:?
No simultaneous bilateral pneumothorax - 27%
Simultaneous bilateral pneumothorax - 6 - 9%
THORACOSCOPY
Minimally invasive method
Very good visualization of lesions
Shorter hospitalization
Rapid return to full physical activity