Immediate chest tube removal at the completion of anterior vertebral tethering is well-tolerated without an increased risk of pulmonary complication.

IF 1.8 Q3 CLINICAL NEUROLOGY
John T Braun, Sofia C Federico, Cornelia Griggs, David M Lawlor, Daniel P Croitoru, Brian E Grottkau
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引用次数: 0

Abstract

Introduction: Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT.

Methods: A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2-5 days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications.

Results: In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2-6 weeks post-operatively and one chylothorax that occurred 1 week post-operatively. Several clinically significant pleural effusions (4/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2-5 days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1).

Conclusion: This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10-11% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2-5 days resulted in no pulmonary complications.

在完成前椎体系扎术后立即拔除胸管是耐受性良好的,不会增加肺部并发症的风险。
虽然在儿童和成人普外科文献中,在内镜胸腔镜手术完成后切除胸管是被广泛接受的,但这种做法从未在接受前椎体系扎术(AVT)治疗AIS的儿童患者中进行过研究。本研究回顾性分析了在AVT完成后连续切除胸管的大量AIS患者的肺部并发症。然后将该系列中肺并发症的发生率与发表的AVT后胸管保留患者的肺并发症发生率进行比较。方法:对所有接受AVT治疗的AIS患者在12年期间的257例(248例原发性/9例翻修)进行回顾性研究,共349例弯曲。在术中放置的349根胸管中,作为手术的常规步骤,323根在手术完成时被拔除,26根在术后保留了2-5天。检查了病人的图表、x线片和CT扫描以确认是否有肺部并发症。结果:257例接受AVT治疗的AIS患者中,233例在AVT完成时切除胸管,4例(1.7%)围手术期,8例(3.4%)迟发性肺部并发症。围手术期并发症包括一例在手术室发现的症状性气胸,需要重新插入胸管;1例静态气胸在没有干预的情况下消失;两处明显的胸腔积液在没有干预的情况下逐渐消失。延迟并发症包括术后2-6周发生的7例胸腔积液和术后1周发生的1例乳糜胸。几例临床上明显的胸腔积液(4/7)需要胸腔穿刺或胸管引流,但随后得到解决。乳糜胸需要胸腔管引流,限制饮食脂肪,并用奥曲肽治疗。在24例患者中,26根胸管因持续漏气并推定为实质损伤(14例),翻修伴有明显粘连(6例),出血障碍(2例),或与肾外翻相关的膈修复(1例)或先天性膈疝(1例),术后保留2-5天。结论:本研究证明了AIS患者在AVT完成后立即拔除胸管的相对安全性。233例患者在AVT完成时取出胸管的肺部并发症发生率为5.1%,与发表的胸管保留后的10-11%的发生率相比是有利的。在24例AVT完成时有保留胸管指征的患者中,胸管保留2-5天未出现肺部并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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