内科胸腔镜在儿童难治性胸膜疾病诊断及治疗中的价值

Thoracoscopy in diagnosis and treatment of pleural diseases in children

目的 探讨内科胸腔镜在儿童胸膜疾病诊断及治疗中的应用价值.方法 回顾性分析2011年5月至2016年8月湖南省人民医院儿童医学中心经内科胸腔镜诊断及治疗的19例难治性胸膜疾病患儿的临床特点和效果.19例患儿中,男15例、女4例,平均年龄（4.8±2.0）岁.发病部位为左侧胸膜13例,右侧胸膜5例,双侧胸膜1例.结果 19例患儿均经内科胸腔镜术成功诊治,无中转开胸病例.10例患儿术前与术后诊断一致,其中脓胸8例,包括肺炎链球菌感染6例,金黄色葡萄球菌感染2例;结核性胸膜炎2例.9例患儿术前诊断不明,术后诊断为结核性胸膜炎3例,支原体感染1例,胸腔异物合并感染1例,脓胸4例.19例患儿均未出现血胸、乳糜胸等并发症.19例患儿术后留置胸腔闭式引流管的平均时间为（4.7±2.3）d,体温恢复正常的平均时间为（2.4±2.6）d,平均住院时间为（6.7±1.8）d.术后无一例患儿应用止痛剂.结论 内科胸腔镜术诊断和治疗难治性儿童胸膜疾病效果满意,且具有创伤小、恢复快、并发症少等优点.

Objective To investigate the value of thoracoscopy in diagnosis and treatment of pleural diseases in children.Method Clinical manifestations and treatment outcomes of 19 patients who had refractory pleural diseases treated with thoracosocy during May 2011 to August 2016 in Hunan Provincial People＆#39;s Hospital were retrospectively analyzed.In 19 cases,15 were male and 4 were female,with an average age of （4.8 ＆#177; 2.0） years.Thirteen patients had left pleural lesion,while 5 patients had right lesion,and 1 had bilateral lesions.Result All cases were successfully treated with thoracoscopy without emergent thoracotomy.Pre-and post operative diagnosis was compatible in 10 cases,including 8 cases of empyema （Streptococcus pneumoniae infection in 6 cases,and Staphylococcus Aureus infection in 2 cases）,and 2 cases of tuberculous pleuritis.Nine patients who had not been clearly diagnosed before surgery were diagnosed to be empyema （4 case）,tuberculous pleuritic （3 cases）,mycoplasma infection （1 case）,and foreign body with infection （1 case） by thoracoscopy.The average duration of post-op closed thoracic drainage was （4.7 ＆#177;2.3） days.The average time to get normal temperature was （2.4 ＆#177; 2.6） days.And the average length of hospital stay was （6.7 ＆#177; 1.8） days.No hemothorax,chylothorax,or need for analgesic occurred.Conclusion Thoracoscopy can be recommended for diagnosis and treatment of refractory pleural lesions diseases in children,with minimal trauma and complications.