Early Approach to Primary Spontaneous Pneumothorax Treatment in Children

Abstract

Objective: Etiology, diagnosis, and treatment of primary spontaneous pneumothorax (PSP) are not well-established and subject to debate in the pediatric age group. Our study aims to clarify the subject and discuss it in the light of available literature.

Material and Methods: We performed a retrospective analysis of the age, sex, etiology, smoking habits, diagnostic methods, pneumothorax percentages, first treatment approach, and treatment results of the patients with PSP by examining the patients’ records. A total of 71 patients, 65 (91.5%) male and six (8.5%) female, who were followed up and treated between 2010 and 2020 were included in the study. Descriptive statistical methods, Shapiro-Wilk test Mann-Whitney U test, Pearson chi-square test, Fisher’s exact test, Fisher-Freeman-Halton exact test were used while evaluating the study data.

Results: The mean age of the patients was 16.23±0.81 (13–18 years). The etiology was not clear in most of the patients. However, among them, 14 (25.5%) patients had bullae and 23 (32.4%) patients had a smoking habit. The diagnosis was made by means of taking medical history, physical examination, and post-anterior (PA) chest X-ray. Treatment with nasal oxygen was initiated in 14 (19.7%) patients with a pneumothorax percentage <20%. For a total of 57 patients the first line of treatment was initiated with tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was performed in cases where tube thoracostomy failed.

Conclusion: Different forms of initial treatment modalities exist for spontaneous pneumothorax. However, we suggest that the first option in patients of the pediatric age group should be clinical follow-up and supportive treatment, if necessary, tube thoracostomy should be applied.

Keywords

• primary spontaneous pneumothorax
• nonoperative
• recurrence
• pediatric

Çocuklarda Primer Spontan Pnömotoraks Tedavisinde Erken Yaklaşım

Abstract

Amaç: Çocuk yaş grubunda Primer Spontan Pnömotoraks (PSP) etyolojisi, tanı ve tedavisi henüz kesinleşmemiş ve tartışmalı bir konudur. Makalemizde konuya açıklık getirme ve literatür eşliğinde tartışılması amaçlanmıştır.

Gereç ve Yöntemler: “Primer Spontan Pnömotoraks (PSP) nedeniyle takip ve tedavi ettiğimiz hastaların yaş, cinsiyet, etyoloji, sigara alışkanlıkları, tanı yöntemleri, pnömotoraks oranları, ilk tedavi yaklaşımımız ve sonuçları hastaların kayıtları incelenerek değerlendirildi. 2010-2020 yılları arasında takip ve tedavi edilen 65’i (%91.5) erkek, 6’sı (%8.5) kız, toplam 71 hasta çalışmaya alındı. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodlar, Shapiro-Wilk testi, Mann-Whitney U test, Pearson ki-kare test, Fisher’s exact test, Fisher-Freeman-Halton exact test kullanıldı.

Bulgular: Hastaların yaş ortalaması 16.23±0.81 (13–18 years)’di. Hastaların çoğunda etyoloji belli değildi. Ancak 14 (%25.4) hastada bül saptanırken, 23 (%32.4) hastanın hikayesinde sigara içme alışkanlığı saptandı. Tanı, hikâye, fizik muayene ve PA Akciğer grafisi ile kondu. Pnömotoraks oranı %20’nin altında olan 14 (%19.7) hastaya nazal oksijen ile tedaviye başlandı. Toplam 57 hastaya ilk tedavi olarak tüp torakostomi uygulandı. Tüp torakostominin başarısız olduğu olgulara video yardımlı torakoskopik cerrahi (VATS) uygulandı.

Sonuç: Spontan pnömotoraks başlangıç tedavi yöntemleri arasında farklı uygulamalar mevcuttur. Ancak çocuklarda ilk seçenek klinik takip ve destek tedavisi gerekirse tüp torakostomi uygulaması şeklinde olmalıdır. Bu uygulamalar kolay, başarı oranı yüksek, güvenli ve etkili bir tedavi yöntemidir. İleri cerrahi uygulamalar seçilmiş olgularda yapılmalıdır.

Keywords

• Primer Spontan Pnömotoraks
• nonoperatif
• nüks
• çocuk

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