Mustafa ERTUĞRUL, Ayper SOMER, Selda HANÇERLİ TÖRÜN, Nuran SALMAN, Nezahat GÜRLER, Tansu SALMAN, Ensar YEKELER, Alaattin ÇELİK

Çocuklarda Plevral Ampiyem: Seksen Beş Vakanın Değerlendirilmesi

Amaç: Çocukluk çağı plevral ampiyem vakalarının klinik seyir, laboratuvar bulguları, tedavi seçenekleri ve prognozlarının retrospektif olarak değerlendirilmesi.Gereç ve Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, İnfeksiyon Hastalıkları Bilim Dalı’nda 1997-2002 yılları arasında yatırılarak izlenen 5 ay-16 yaş arası 85 plevral ampiyemli hastanın 30 kız, 55 erkek yatış dosyaları retrospektif olarak incelenmiştir. Plevral ampiyem tanısı klinik bulgular ve akciğer grafisi sonuçlarına göre konmuş ve tüm vakalarda torakosentez ile desteklenmiştir.Bulgular: Başvuru öncesi yakınmaların süresi ortalama 7 gün idi Dağılım: 1-30 gün . En sık saptanan başvuru yakınmaları ateş, öksürük ve nefes darlığı idi. Plevral sıvı kültüründe üreme % 24.7 hastada saptandı. En sık üreyen patojenler Staphylococcus aureus n=11 , Streptococcus pneumoniae n=5 , Haemophilus influenzae n=2 , alfa-hemolitik streptokoklar n=2 ve enterokoklar n=1 idi. Tüm hastalara antibiyoterapi verilirken vakaların % 78.8’ine kapalı toraks tüpü drenajı uygulandı. Kırk üç hastada % 50.6 dekortikasyon girişimi gerekti. Operasyon kararı ultrasonografide plevral membran kalınlaşması saptanması n=27 , loküle koleksiyon varlığı n=9 veya bronkoplevral fistül varlığında n=2 alındı. Cerrahi girişim gerektiren 43 vakadan 9’unda akciğer apsesi ile birlikte olan reküren ampiyem n=5 , bronkoplevral fistül n=2 ve pnömotoraks n=2 gibi ciddi komplikasyonlar gelişmişti. Bilgisayarlı akciğer tomografisinde plevral kalınlaşmanın varlığı, başvuruda alınan plevral sıvı örneğinde düşük pH ve glukoz değerlerinin saptanması ve hastaneye geç başvuru tıbbi tedaviye yetersiz yanıt ile birlikteydi. Hastanede yatış süresi 6-81 gün arasındaydı. Ölen vaka veya uzun süreli komplikasyon kaydedilmedi.Sonuçlar: Plevral ampiyemli tanısı alan çocuklar erken tanı konulduğunda uygun antibiyotik tedavisi ve gerekli vakalarda kapalı toraks tüp drenajı ile başarılı bir şekilde tedavi edilmektedirler. Ancak, kronik ampiyem evresinde gelen gecikmiş vakalarda dekortikasyon girişimi gerekmektedir. Dekortikasyon gerektiren vakalarda da prognoz son derece iyidir

Anahtar Kelimeler:

Plevral ampiyem, çocuk, dekortikasyon, eksüda

Pleural Empyema in Children: A Review of 85 Cases

Aim: To analyze retrospectively the clinical and laboratory characteristics, management, complications and outcome of pleural empyema in children.Material and Methods: The medical records of 85 children 30 girls, 55 boys aged between 5 months and 16 years treated for empyema in the Department of Pediatric Infectious Diseases, Istanbul University Istanbul Medical Faculty Hospital from 1997 to 2002 was retrospectively reviewed. The diagnosis of pleural empyema was made on clinical findings and chest X-ray and confirmed in all cases by needle thoracocentesis.Results: The median duration of symptoms prior to admission was 7 days range 1-30 days . Fever, cough and dyspnoea were the most common symptoms. A definitive bacteriological diagnosis was made in 21 of 85 patients 24.7 % . The common pathogens isolated were Staphylococcus aureus n=11 ; others included Streptococcus pneumoniae n=5 , Haemophilus influenzae n=2 , alpha-hemolytic streptococci n=2 , and enterococci n=1 . All patients were treated with antibiotics and pleural fluid drainage was settled in 78.8% of cases. Forty-three children 51 % underwent thoracotomy and debridement or decortication. The decision to operate was made on the basis of either the ultrasound scan finding of the thickness of the pyogenic membrane n=27 , a loculated collection n=9 or bronchopleural fistula n=2 . Nine out of 43 children treated surgically experienced significant complications including recurrent empyema with lung abscess n=5 , bronchopleural fistula n=2 , and pneumothorax n=2 . CT evidence of pleural peel, low pleural pH and glucose concentration and late referral to the hospital were associated with a poor response to medical management. The duration of hospitalization ranged from 6 to 81 days. There were no deaths and no long-term complications identified.Conclusions: We concluded that appropriate antibiotics with early closed-chest tube drainage are adequate to achieve clinical and physiologic resolution. Patients referred late to the hospital may require further surgical intervention. The long term prognosis is excellent

Keywords:

Pleural empyema, child, decortication, exuda,

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