Ferguson M K
Department of Surgery, the University of Chicago, IL 60637, USA.
Semin Respir Infect. 1999 Mar;14(1):73-81.
Most patients with empyema require surgical intervention. Selection of therapy is based on the patient's overall condition, on the cause of the empyema, and on the stage of empyema progression. Parapneumonic effusions in the exudative or early fibrinopurulent stage may be responsive to tube thoracostomy and may not require further intervention in 65% of patients. More complicated parapneumonic effusions require thoracoscopic or open thoracotomy for debridement or decortication and are successfully managed in over 95% of patients. Empyemas that develop postoperatively are more challenging to diagnose and treat. Open thoracotomy is usually necessary unless patients are too ill to tolerate major surgery, in which case simple open drainage is an alternative. Closure of any bronchopleural fistula is necessary before an empyema can be eradicated. In patients with empyema associated with an extrapulmonary infectious process, control of the primary source of infection is required before definitive therapy of the empyema is undertaken. The overall success rate of therapy for empyema is greater than 90% and the associated mortality rate is about 8%.
大多数脓胸患者需要手术干预。治疗方法的选择基于患者的整体状况、脓胸的病因以及脓胸进展的阶段。处于渗出性或早期纤维脓性阶段的肺炎旁胸腔积液，对胸腔闭式引流可能有反应，65%的患者可能无需进一步干预。更复杂的肺炎旁胸腔积液需要胸腔镜或开胸手术进行清创或剥脱术，超过95%的患者能成功治愈。术后发生的脓胸诊断和治疗更具挑战性。通常需要开胸手术，除非患者病情太重无法耐受大手术，在这种情况下，简单的开放引流是一种选择。在根除脓胸之前，必须闭合任何支气管胸膜瘘。对于与肺外感染过程相关的脓胸患者，在对脓胸进行确定性治疗之前，需要控制感染的主要来源。脓胸治疗的总体成功率大于90%，相关死亡率约为8%。
