Thoracoscopy in children with complicated parapneumonic pleural effusion at the fibrinopurulent stage: a multi-institutional study* Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional
نویسندگان
چکیده
Objective: To determine the efficacy of thoracoscopy in the management of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage. Methods: Retrospective study of 99 children submitted to thoracoscopy for the treatment of complicated parapneumonic pleural effusion at the fibrinopurulent stage between November of 1995 and July of 2005. The mean age was 2.6 years (range, 0.4-12 years), and 60% were males. Thoracoscopy was performed at three different hospitals following the same treatment algorithm. Results: Thoracoscopy was effective for 87 children (88%). In 12 (12%), a second surgical procedure was required: another thoracoscopy (n = 6) or thoracotomy/thoracostomy (n = 6). Mean duration of chest tube drainage following successful thoracoscopy was 3 days vs. 10 days in patients submitted to a second procedure (p < 0.001). In all of the children, the pleural infection resolved after treatment. Thoracoscopy-related complications included air leak (30%), chest tube bleeding (12%), subcutaneous emphysema associated with trocar insertion (2%) and surgical wound infection (2%). None of the children required additional surgical procedures due to the complications. Conclusions: The effectiveness of thoracoscopy in children with parapneumonic pleural effusion at the fibrinopurulent stage was 88%. The procedure was safe, with a low rate of severe complications. Thoracoscopy should be the first-choice treatment for children with parapneumonic pleural effusion at the fibrinopurulent stage.
منابع مشابه
Thoracoscopy in children with complicated parapneumonic pleural effusion at the fibrinopurulent stage: a multi-institutional study.
OBJECTIVE To determine the efficacy of thoracoscopy in the management of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage. METHODS Retrospective study of 99 children submitted to thoracoscopy for the treatment of complicated parapneumonic pleural effusion at the fibrinopurulent stage between November of 1995 and July of 2005. The mean age was 2.6 years (ra...
متن کامل[Surgical treatment of parapneumonic pleural effusion and its complications].
OBJECTIVE Surgical treatment of parapneumonic pleural effusion in children is controversial. The type of intervention is based mainly on personal experience and on the small number of reported cases. This article aims at presenting a literature review and the authorś experience in the surgical management of parapneumonic pleural effusion in children. SOURCES Data were searched in the Medline ...
متن کاملEvaluation of Predictive Factors of Empyema in Children with Parapneumonic Pleural Effusion
Background Empyema is a complication of bacterial pneumonia which has a particular importance due to its significant morbidity and mortality in children. The aim of this study was to investigate the prognostic factors of empyema in children with parapneumonic pleural effusion. Materials and Methods: This retrospective cross-section...
متن کاملParapneumonic pleural effusion: early versus late thoracoscopy
OBJECTIVE To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. METHODS This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or locu...
متن کاملPathoPhysIology of ParaPneumonIc effusIon
of large amount of pleural fluid with many polymorphonuclear leukocytes, bacteria and cellular debris. The pleural fluid becomes clottable due to leakage of plasma proteins and loss of fibrinolytic activity in pleural space resulting in the formation of thick layer of fibrin over parietal and visceral pleura. The migration of fibroblasts into pleural space leads to collagen deposition and along...
متن کامل