Hürtgen M, Witte B, Friedel G, Toomes H
Abteilung für Thoraxchirurgie, Klinik Schillerhöhe.
Chirurg. 1999 Apr;70(4):464-8. doi: 10.1007/s001040050673.
Video-assisted thoracoscopic (VAT) debridement is gaining importance in the fibrino-purulent phase of empyema thoracis. However, evaluation of this access compared with mere chest tube drainage or thoracotomy remains unsatisfactory. A total of 356 parapneumonic empyemas from 1986 to 1997 were retrospectively analyzed concerning the results after primary treatment (chest tube 225, thoracotomy 80, VAT 51). The three groups did not differ significantly for gender and associated diseases. Median age of the chest tube drainage group (54 years) was higher than for thoracotomy (43.5 years) or VAT (39 years). Median duration of chest tube treatment after thoracotomy (7 days) was shorter than after VAT (13 days) or chest tube drainage (20 days) (P < 0.0001). The more invasive procedures were also superior to the lesser invasive treatment concerning duration of postoperative hospitalization, recurrence rate and treatment failures. In spite of its better results thoracotomy will be pushed back by VAT in the treatment of empyema thoracis. Acceptance of VAT is reflected in rising numbers of admissions. Based on these retrospective results we are planning a prospective multicenter trial to evaluate the indication for VAT in empyema thoracis.
电视辅助胸腔镜（VAT）清创术在脓胸的纤维脓性期正变得越来越重要。然而，与单纯胸腔闭式引流或开胸手术相比，对这种手术方式的评估仍不尽人意。回顾性分析了1986年至1997年间共356例肺炎旁脓胸患者的初始治疗结果（胸腔闭式引流225例、开胸手术80例、VAT手术51例）。三组患者在性别和相关疾病方面无显著差异。胸腔闭式引流组的中位年龄（54岁）高于开胸手术组（43.5岁）或VAT手术组（39岁）。开胸手术后胸腔闭式引流的中位时间（7天）短于VAT手术后（13天）或单纯胸腔闭式引流（20天）（P < 0.0001）。在术后住院时间、复发率和治疗失败率方面，侵入性更强的手术方式也优于侵入性较小的治疗方式。尽管开胸手术效果更好，但在脓胸治疗中VAT手术将逐渐取代开胸手术。VAT手术接受度的提高体现在入院人数的增加上。基于这些回顾性结果，我们正计划开展一项前瞻性多中心试验，以评估VAT手术在脓胸治疗中的适应证。
