Ultrasound-guided thoracoscopic debridement in children with fibrinothorax

Abstract

BACKGROUND: With the spread of endoscopic procedures, thoracoscopy has become an ideal method for the surgical treatment of pleural complications. Ultrasound examination of the pleural cavity made it possible to differentiate the nature of the pleural contents and timely use of thoracoscopic sanitation of the pleural cavity. AIM: This study aimed to conduct ultrasound monitoring of the complete restoration of the pleural cavity after video-assisted thoracoscopic debridement in children with fibrinothorax. MATERIALS AND METHODS: The study was conducted in the childrens surgical department of the Republican Childrens Clinical Hospital of Health Ministry of the Chuvash Republic. From 2011 to 2019, 31 children aged 1 month to 18 years were diagnosed with community-acquired pneumonia complicated by fibrinothorax, and thoracoscopic debridement and drainage of the pleural cavity were performed. During hospitalization, before thoracoscopy, 13 ultrasound examinations of the pleural cavities and lungs were performed in all children, which made it possible to determine methods of management. After thoracoscopic debridement, ultrasound examination of the pleural cavities was performed 37 times during hospitalization and 12 times monthly for 36 months after discharge from the hospital until the pleural cavity was completely restored. RESULTS: Ultrasound monitoring of the pleural cavities and lungs after thoracoscopic debridement at the outpatient stage showed that changes in the pleural cavity and lung parenchyma can last up to 6 months, while childrens health status was satisfactory. CONCLUSIONS: Preoperative and postoperative ultrasound monitoring can adequately assess the overall state of the pleural cavities and lungs. Changes in the pleural cavity after thoracoscopic debridement under ultrasound guidance are observed later than by X-ray. In this regard, after discharge from the hospital, children with complicated purulent and destructive pneumonia who underwent thoracoscopic debridement need ultrasound monitoring of the pleural cavity until it is completely restored.