Riquet M, Hubsch J P, Le Pimpec Barthes F, Abitbol P, Souilamas R, Zukerman C, Manac'h D
Service de Chirurgie Thoracique, Hôpital Laënnec, Paris.
Rev Mal Respir. 1999 Nov;16(5):817-22.
Thoracic empyemas may occur during the course of lung cancer as a post-thoracotomy complication, or after pleural drainage and/or chemotherapy in cases when surgery was unfeasible, or may complicate the natural history of the disease and appear as the clinical event that led to its discovery. This latter situation is a challenge requiring to cure the infection in order to further treat the underlying lung cancer. We reviewed the cases of 18 men aged between 46 and 79 years that were referred to our surgical department from 1984 to 1996 for management of a thoracic empyema with an underlying lung cancer. Initial presentation of empyemas, lung tumor characteristics, treatments performed and their results were analyzed so as to formulate guidelines if possible. Mean duration of 17 empyemas before arrival was 26 days (8 to 60 days) and in one case empyema occurred during diagnostic work-up of an excavated lesion. Frank pus was observed in all cases and micro-organisms were identified in 13 cases. Empyema and diagnosis of lung cancer were concomitant in 15 cases: in 3 cases lung neoplasia was already diagnosed but patients had refused surgery. Empyema was treated by under water-seal chest tube drainage with adjunct fibrinolytic therapy in all cases; 2 elderly and cachectic patients suffering metastatic diffusion died rapidly. The other 16 recovered within one month. In 7 cases management was limited to medical treatment (palliative n = 2, chemotherapy n = 1, chemo combined radiotherapy n = 2 and radiotherapy alone n = 2) but only short survivals were observed (inferior to 10 months). Surgery was possible in 9 (pneumonectomy n = 8, lobectomy n = 1); there was no death; postsurgical empyemas complicated the cause twice but were easily cured by drainage; long term survivals were observed in 3 cases that were p NO. Pleural empyema complicating lung cancer is a rare but challenging situation. Once the pleural empyema has been controlled, surgical resection must be performed when indicated: postoperative complications are rare and long-term survival is possible.
脓胸可能在肺癌病程中作为开胸手术后的并发症出现，或在手术不可行的情况下，于胸腔引流和/或化疗后发生，也可能使疾病的自然病程复杂化，并表现为导致其被发现的临床事件。后一种情况是一项挑战，需要治愈感染以便进一步治疗潜在的肺癌。我们回顾了1984年至1996年间因合并潜在肺癌的脓胸而转诊至我们外科的18例年龄在46至79岁之间男性患者的病例。分析了脓胸的初始表现、肺部肿瘤特征、所采取的治疗方法及其结果，以便尽可能制定指导原则。17例患者在入院前脓胸的平均持续时间为26天（8至60天），1例脓胸发生在对一个空洞性病变进行诊断检查期间。所有病例均观察到有脓性渗出物，13例中鉴定出了微生物。15例患者脓胸与肺癌诊断同时存在：3例患者肺癌已被诊断，但拒绝手术。所有病例均通过水封胸腔闭式引流并辅助纤维蛋白溶解疗法治疗脓胸；2例患有转移性扩散的老年体弱患者很快死亡。其他16例在1个月内康复。7例患者的治疗仅限于内科治疗（姑息治疗2例、化疗1例、化疗联合放疗2例、单纯放疗2例），但观察到的生存期均较短（不足10个月）。9例患者可行手术（全肺切除术8例、肺叶切除术1例）；无死亡病例；术后脓胸使病情复杂化两次，但通过引流很容易治愈；3例pNO病例观察到长期生存。合并肺癌的脓胸是一种罕见但具有挑战性的情况。一旦脓胸得到控制，如有指征必须进行手术切除：术后并发症罕见，且有可能实现长期生存。
