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Çocuklarda Ampiyem Tedavisinde Tüp Torakostomi ile Torakoskopik Debridmanın Karşılaştırılması

Year 2021, Volume 9, Issue 2, 59 - 65, 31.08.2021
https://doi.org/10.21765/pprjournal.903012

Abstract

Amaç: Ampiyem çocuklarda, pnömoni sonrası gelişen önemli bir sorundur. Antibiyoterapi ve pürülan sıvının drenajı tedavinin temelini oluşturur. Drenaj amacıyla çeşitli yöntemler kullanılır. Minimal invaziv yöntemlerin de gelişmesiyle günümüzde torakoskopik debridman yaygın olarak kullanılmaktadır. Bu çalışmada, kliniğimizde torakoskopik debridman kullanılmaya başlamadan önceki dönemde ampiyem nedeniyle tedavi edilen olgularla, torakoskopik debridman kullanılmaya başladıktan sonraki dönemde tedavi edilen olgular karşılaştırılmışlardır.

Gereç ve yöntem: Bu amaçla kliniğimizde torakoskopik debridman öncesi olgular (Grup 1, n=25) ile torakoskopik debridman sonrası olgular (Grup 2, n=28) çeşitli yönleriyle karşılaştırılmışlardır. İlk gruptaki tüm olgulara tüp torakostomi uygulanırken, ikinci gruptaki olgulara öncesinde tüp torakostomi uygulansın ya da uygulanmasın torakoskopik debridman uygulanmıştır.

Bulgular: Torakoskopik debridman uygulanan grupta, uygulanmayan gruba göre ateş yüksekliği, lökositoz, solunum sıkıntısı ve pürülan drenaj daha kısa sürmüş, yani klinik iyileşme daha hızlı olmuştur. Torakoskopik debridman uygulanan grupta, uygulanmayan gruba göre tüp torakostomi süresi daha kısa, torakotomi ihtiyacı daha az saptanmıştır.

Sonuç: Torakoskopik debridman, çocuklarda ampiyemde iyileşmeyi hızlandırmaktadır. Bunda, plevral boşluktaki fibrin ve septasyonların kamera görüşü altında daha etkili ve hızlı debride edilmesi etkilidir. Bu nedenle ampiyem tedavisinde ilk seçenek zaman kaybetmeden torakoskopik debridman olmalıdır.

References

  • Reference 1. Tan TQ, Mason EO Jr, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumonia. Pediatrics. 2002; 110:1-6.
  • Reference 2. Kercher KW, Attori RJ, Hoover D, et al. Thorascopic decortication as first-line therapy for pediatric parapneumonic empyema, a case series. Chest. 2000; 118:24-27.
  • Reference 3. Jaffe A, Calder AD, Owens CM, et al. Role of routine computed tomography in paediatric pleural empyema. Thorax. 2008; 63:897-902.
  • Reference 4. Ulku R, Onen A, Onat S, et al. Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas. Pediatr Surg Int. 2004; 20:520-524.
  • Reference 5. Wurnig PN, Wittmer V, Pridun NS, et al. Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg. 2006; 81:309-313.
  • Reference 6. Kurt BA, Winterhalter KM, Connors RH, et al. Therapy of parapneumonic effusions in children: Video assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics. 2006; 118:e547-553.
  • Reference 7. Aziz A, Healey JM, Qureshi F, et al. Comparative Analysis of Chest Tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect. 2008; 9(3):317-323.
  • Reference 8. Schneider CR, Gaudere MWL, Blackhurst D, et al. Am Surg. 2010; 76(9):957-961. Reference 9. Gates RL, Caniano DA, Hayes J, et al: Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg. 2004; 39(3):381-386.
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  • Reference 11. Rodriguez JA, Hill CB, Loe WA Jr, et al. Video-assisted thorascopic surgery for children with stage II empyema. Am Surg. 2000; 66:569-573.
  • Reference 12. Doski JJ, Lou D, Hicks BA, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg. 2000; 35:265-270.
  • Reference 13. Rescorla FJ, West KW, Gingalewski CA, et al. Efficacy of primary and secondary video-assisted thoracic surgery in children. J Pediatr Surg. 2000; 35:134-138.
  • Reference 14. Subramaniam R, Joseph VT, Tan GM, et al. Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children. J Pediatr Surg. 2001; 36:316-319.
  • Reference 15. Kern JA, Rodgers BM. Thoracoscopy in the management of empyema in children. J Pediatr Surg. 1993; 28:1128-1132.
  • Reference 16. Wait MA, Sharma S, Hohn J, et al. A randomized trial of empyma therapy. Chest. 1997; 111:1548-1551.
  • Reference 17. Pacilli M, Nataraja RM. Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis: Systematic review and meta-analysis. Paediatr Respir Rev. 2019; 30:42-48. Reference 18. St. Peter SD, Tsao K, Harrison C, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009; 44:106-111.
  • Reference 19. Mahant S, Cohen E, Weinstein M, et al. Video-assisted thorascopic surgery vs chest drain with fibrinolytics for the treatment of pleural empyema in children: a systematic review of randomized controlled trials. Arch Pediatr Adolesc Med. 2010; 164(2):201-203.
  • Reference 20. Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012; 47:2101-2110.
  • Reference 21. Scarci M, Abah U, Solli P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015; 48(5):642-653.
  • Reference 22. Coote N, Kay E, Coote N. Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev. 2005; CD001956.
  • Reference 23. Lawrence DR, Ohri SK, Moxon RE, et al. Thoracoscopic debridement of empyema thoracis. Ann Thorac Surg. 1997; 64:144850.
  • Reference 24. Rodgers BM. Thorascopic procedures in children. Semin Pediatr Surg. 1993; 2:182-189.

Comparison of tube thoracostomy and thoracoscopic debridement in the treatment of empyema in children

Year 2021, Volume 9, Issue 2, 59 - 65, 31.08.2021
https://doi.org/10.21765/pprjournal.903012

Abstract

Objective: Empyema is an important problem that develops after pneumonia in children. Antibiotherapy and drainage of purulent fluid form the basis of treatment. Various methods are used for drainage. Thoracoscopic debridement is widely used today with the development of minimally invasive methods. In this study, patients who were treated for empyema in the period before the use of thoracoscopic debridement in our clinic were compared with the patients who were treated in the period after the use of thoracoscopic debridement. Materials and methods: For this purpose, cases before thoracoscopic debridement (Group 1, n = 25) and patients after thoracoscopic debridement (Group 2, n = 28) were compared in various aspects. While tube thoracostomy was applied to all cases in the first group, thoracoscopic debridement was applied to the cases in the second group whether or not tube thoracostomy was applied. Results: Fever, leukocytosis, respiratory distress and purulent drainage lasted shorter in the group in which thoracoscopic debridement was applied, in other words, clinical improvement was faster. In the group in which thoracoscopic debridement was applied, the duration of tube thoracostomy was shorter and the need for thoracotomy was less than in the group not applied. Conclusion: Thoracoscopic debridement accelerates the recovery of empyema in children. In this, it is effective to debride fibrin and septations in the pleural space more effectively and quickly under the camera view. Therefore, thoracoscopic debridement should be the first option in the treatment of empyema without delay.

References

  • Reference 1. Tan TQ, Mason EO Jr, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumonia. Pediatrics. 2002; 110:1-6.
  • Reference 2. Kercher KW, Attori RJ, Hoover D, et al. Thorascopic decortication as first-line therapy for pediatric parapneumonic empyema, a case series. Chest. 2000; 118:24-27.
  • Reference 3. Jaffe A, Calder AD, Owens CM, et al. Role of routine computed tomography in paediatric pleural empyema. Thorax. 2008; 63:897-902.
  • Reference 4. Ulku R, Onen A, Onat S, et al. Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas. Pediatr Surg Int. 2004; 20:520-524.
  • Reference 5. Wurnig PN, Wittmer V, Pridun NS, et al. Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg. 2006; 81:309-313.
  • Reference 6. Kurt BA, Winterhalter KM, Connors RH, et al. Therapy of parapneumonic effusions in children: Video assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics. 2006; 118:e547-553.
  • Reference 7. Aziz A, Healey JM, Qureshi F, et al. Comparative Analysis of Chest Tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect. 2008; 9(3):317-323.
  • Reference 8. Schneider CR, Gaudere MWL, Blackhurst D, et al. Am Surg. 2010; 76(9):957-961. Reference 9. Gates RL, Caniano DA, Hayes J, et al: Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg. 2004; 39(3):381-386.
  • Reference 10. Meier AH, Smith B, Raghavan A, et al. Rational treatment of empyema in children. Arch Surg. 2000; 135:907-912.
  • Reference 11. Rodriguez JA, Hill CB, Loe WA Jr, et al. Video-assisted thorascopic surgery for children with stage II empyema. Am Surg. 2000; 66:569-573.
  • Reference 12. Doski JJ, Lou D, Hicks BA, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg. 2000; 35:265-270.
  • Reference 13. Rescorla FJ, West KW, Gingalewski CA, et al. Efficacy of primary and secondary video-assisted thoracic surgery in children. J Pediatr Surg. 2000; 35:134-138.
  • Reference 14. Subramaniam R, Joseph VT, Tan GM, et al. Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children. J Pediatr Surg. 2001; 36:316-319.
  • Reference 15. Kern JA, Rodgers BM. Thoracoscopy in the management of empyema in children. J Pediatr Surg. 1993; 28:1128-1132.
  • Reference 16. Wait MA, Sharma S, Hohn J, et al. A randomized trial of empyma therapy. Chest. 1997; 111:1548-1551.
  • Reference 17. Pacilli M, Nataraja RM. Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis: Systematic review and meta-analysis. Paediatr Respir Rev. 2019; 30:42-48. Reference 18. St. Peter SD, Tsao K, Harrison C, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009; 44:106-111.
  • Reference 19. Mahant S, Cohen E, Weinstein M, et al. Video-assisted thorascopic surgery vs chest drain with fibrinolytics for the treatment of pleural empyema in children: a systematic review of randomized controlled trials. Arch Pediatr Adolesc Med. 2010; 164(2):201-203.
  • Reference 20. Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012; 47:2101-2110.
  • Reference 21. Scarci M, Abah U, Solli P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015; 48(5):642-653.
  • Reference 22. Coote N, Kay E, Coote N. Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev. 2005; CD001956.
  • Reference 23. Lawrence DR, Ohri SK, Moxon RE, et al. Thoracoscopic debridement of empyema thoracis. Ann Thorac Surg. 1997; 64:144850.
  • Reference 24. Rodgers BM. Thorascopic procedures in children. Semin Pediatr Surg. 1993; 2:182-189.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Halil İbrahim TANRİVERDİ (Primary Author)
MANISA CELAL BAYAR UNIVERSITY, SCHOOL OF MEDICINE
0000-0002-2760-9954
Türkiye

Publication Date August 31, 2021
Acceptance Date June 11, 2021
Published in Issue Year 2021, Volume 9, Issue 2

Cite

Vancouver Tanriverdi H. İ. Comparison of tube thoracostomy and thoracoscopic debridement in the treatment of empyema in children. Pediatric Practice and Research. 2021; 9(2): 59-65.