CLINICAL STUDY AND THE ROLE OF THORACOSCOPY TO EVALUATE MEDIASTINAL MASSES IN CHILDREN
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 49
Abstract
BACKGROUND Mediastinal masses in infants and children comprise a heterogenous group of lesions which range from embryonic to neoplastic origin. The various surgical approaches to mediastinal masses include mediastinoscopy, Video-assisted Thoracoscopic Surgery (VATS), anterior thoracotomy, median sternotomy, and standard posterolateral thoracotomy. Of these, Video-assisted Thoracoscopic Surgery (VATS) is advantageous for evaluation and treatment of mediastinal masses. MATERIALS AND METHODS A prospective case series was conducted over a period of 3 years from March 2013 to August 2016 on 15 patients with mediastinal masses who presented to the tertiary care hospital. The patients underwent detailed clinical assessment. Depending on the anatomic location, clinical presentation and resectability noted in radiological investigation, a decision was taken on the type of intervention. All patients were operated under general anaesthesia, 10 patients underwent open thoracotomy through posterolateral and anterolateral thoracotomies, done for posterior or anterior mediastinal masses respectively. Five patients underwent Video-assisted Thoracoscopic Surgery (VATS). Two patients had masses in posterior mediastinum and three in anterior mediastinum. The patients with severe respiratory distress and those with evidence of compression of trachea were excluded. All patients were followed up to a 3-year period with chest x-ray, Ultrasound, tumour markers if indicated. RESULTS The study was statistically analysed on 15 children with mediastinal masses. Of the 15 children, 8 were boys & 7 were girls and the masses were located mostly in the anterior mediastinum in 8 (53%). The mean age was 15.65 months. The mediastinal masses were benign in 12 patients, malignant in 3. Air leaks stopped at a median time interval of 1 ± 1.66 days and pleural drainage at 2 ± 1.4 days in VATS; on contrary air leaks stopped at a mean interval of 2 ± 1.46 days and pleural drainage at 3 ± 1.46 days following open thoracotomy. The lung expanded clinically 1 ± 1.48 days and radiologically 2 ± 1.08 days earlier in VATS cases. The postoperative pain was less in VATS and requirement of analgesia was minimal when compared to open thoracotomy. The postoperative hospital stay was longer in open thoracotomy cases when compared to VATS. CONCLUSION Mediastinal masses are comparatively rare and most of the lesions came to attention before one year of age. Neurenteric cysts and tuberculosis are the common aetiologies. This study concludes that Video-assisted Thoracoscopic Surgery is far superior to open thoracotomy.
Authors and Affiliations
Kannepalli Srinivas, Goriparthy Ratnakumari
Keywords
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- EP ID EP219119
- DOI 10.14260/Jemds/2017/817
- Views 86
- Downloads 0
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