Value of thoracoscopic pericardial window in diagnosis and treatment of pericardial effusion in children

Abstract:

Objective：To investigate the clinical value of thoracoscopic pericardial window（TPW） in the diagnosis and treatment of pericardial effusion in children by summarizing related experience. Methods：A retrospective analysis was performed for the clinical data of 63 children who underwent TPW surgery in our hospital from January 2012 to May 2018. There were 39 boys and 24 girls，aged 7.0-194.0 （93.60±43.70） months，with a body weight of 2.95-51.00 kg[20.00（17.00，28.00） kg] and a course of disease of 2-180 days[10（5，27） days]. Of all children，15 had moderate pericardial effusion and 48 had severe pericardial effusion. Results：For these 63 children，the area of TPW was 4-30 cm2[6（4，11） cm2]，intraoperative blood loss was 1-50 mL[5（2，5） mL]，and the time of operation was 15-310 minutes[65（40，90） minutes]. Of all children，4 were converted to open surgery，53 underwent pleural effusion drainage，and 15 underwent pleural exfoliation during the same period. The duration of postoperative mechanical ventilation was 0.00-480.0 hours[0.00（0.00，1.50） hours]. The children stayed in the intensive care unit for 0-27 days[3（2，4） days]，with a duration of chest tube drainage of 2-39 days[5（4，9） days] and a length of postoperative hospital stay of 5.0-57.0 days[11.0（10，15.5） days]. The pain score for all children ranged from 0 to 4 points[1（0，2） points]. The etiological diagnosis showed pyogenic effusion in 4 children（6.3%），paragonimiasis pericarditis in 34 children（54.0%），tuberculous effusion in 3 children（4.8%），idiopathic effusion in 18 children（28.6%），chylopericardium in 3 children（4.8%），and T lymphoblastic lymphoma in 1 child（1.6%）. Of all children，39（61.90%） had a confirmed diagnosis based on pathological examination. As for postoperative complications，2 children experienced atelectasis and 1 experienced postoperative hemorrhage and was given surgical treatment. A total of 62 children were cured and discharged. A total of 56 children were followed up for 6-24 months，and no recurrence of pericardial effusion or pericardial constriction was observed. Conclusion：TPW for children has the advantages of little trauma，mild postoperative pain，and small incision and can be used to obtain the pathological diagnosis of pericardial effu－sion. It is safe and effective and can be used as the preferred diagnostic and therapeutic regimen for children with moderate or severe pericardial effusion in qualified hospitals.