الفهرس 
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Abstract
Seventy five patients below the age of 18 years transferred to the Cardiothoracic Surgery Department in Alexandria University Hospital diagnosed with PPE were managed using either ICT drainage or VATS. Patients managed with ICT drainage which included a total of 35 patients were included in group I and those managed using VATS which included a total of 40 patients were included in group II. The age in our study ranged from 2 to 15 years.
History talking, physical examination, laboratory work up as well as radiological investigation including CXR, CT and US chest were done to all patients. All 75 patients were febrile, and cough was the most common symptom, followed by tachypnea and dyspnea.
Radiological evidence of pleural effusion ranging from mild to severe was detected using CXR, non-contrast CT and US. CT scan was most useful in differentiating between lobar and bronchopneumonia. US-Chest detected the pleural pathologies and played an important role in visualizing fibrin threads, pleural fluid thickness and septations. The degree of pleural fluid thickness, amount of fibrin threads and septations offered valuable data in predicting the outcome in both groups especially in those patients managed by ICT drainage.
S Aureus was the most common pathogen isolated from the pleural fluid and the majority of cultures were sensitive to penicillin. The second most common pathogen was S Pneumonia and only a few cultures were sterile owing to the long use of antibiotics prior to culture.
Large chest tube drainage from 22 to 24 F were used in our study owing to the lack of availability of smaller chest drains in our hospital in group I. UPVATS as well as MPVATS were used in patients operated upon in group II. MPVATS included either 2 ports or 3 ports. Out of 40 patients in group II, UPVATS was used in 29 patients, MPVATS (2 ports) was used in 9 patients and MPVATS (3 ports) was used in 2 patients.
The amount of pleural fluid drained by group I was significantly more than that in group II. This is related to the fact that patients in group I required a longer drainage time for complete resolution. The longer duration of ICT with the persistence of the underlying pathology during the longer hospital stay resulted in more effusion and thus a higher amount of fluid. In group I, the min, max and mean were 170, 510 and 291.14 ± 94.86 ml respectively compared to a min, max and mean of 70, 320 and 156.50 ± 76.28 ml in group II.
Ninety percent of group II patients showed complete resolution and only 10 % (4 patients) required a secondary intervention in the form of bronchoscopy for the management of partial lung collapse. In group I however failure rate was 82.9%. Which included a total of 29 patients and only 6 patients had complete resolution. Nine patients developed encysted effusion, 4 developed BPF, 5 had thickened pleural peel, 7 cases were presented with total lung collapse and 5 patients had partial lung collapse. In group I, complications were managed either by open surgery (postero-lateral thoracotomy) or VATS (UPVATS or MPVATS), depending on the underlying pathology and its severity.
The minimum, maximum and mean hospital stay after primary intervention ranged from 4 to 23 days with a mean of 11.06 days in the first group and 2 to 4 days with a mean of 2.43 days in the second group. For those patients requiring secondary intervention, minimum, maximum and mean hospital stay were 0.0, 10.0 and 3.74 ± 2.79 in group I and 0.0, 5.0 and 0.45 ± 1.38 in group II. Both results showed a significant statistical difference with a shorter hospital stay in the second group. The THS expressed as minimum, maximum and mean were 5.0, 29.0 and 14.77 ± 7.12 days consecutively in the first group and 5.0, 14.0 and 7.68 ± 2.07 days in the second group. This also showed a significant statistical difference with a shorter THS in the second group.
In order to produce a more accurate result and increase the scope of our study, we further divided each group into two subgroups, failed and resolved. Different parameters in the failed and resolved subgroups were compared to each other. The failed subgroup included a total of 33 patients, 29 patients from group I and 4 patients in group II. The resolved subgroup included a total of 42 patients, 6 patients in group I and 36 patients in group II.
Considering the period in days after the intervention, there was no statistical significant difference in the failed subgroup between group I and II but a significant statistical difference was noted in the resolved subgroup. Further comparison was performed regarding the amount of pleural fluid drained between the two subgroups. Significant statistical difference was seen between both the failed and resolved subgroups with a smaller amount of fluid drainage in group II.