Al-Kattan K M
Division of Thoracic Surgery, King Khalid University Hospital, P.O. Box 7805, Riyadh, Saudi Arabia.
Eur J Cardiothorac Surg. 2000 Mar;17(3):251-4. doi: 10.1016/s1010-7940(99)00370-x.
In an attempt to establish a treatment protocol for tuberculous empyema, we retrospectively reviewed our experience over a 3-year period.
Between January 1996 and December 1998, 26 patients (23 male and three female) with an average age of 33.8 years (range 18-61 years) presented with tuberculous empyema. The empyema was right-sided in 13, left-sided in 12 and bilateral in one patient. Patients presented with respiratory symptoms for a mean duration of 4.43 months (range 1-48 months). All patients had a computerized scan of the chest and managed according to the stage of empyema.
In patients with exudative empyema (n=4) the fluid was aspirated, but one patient required intercostal tube (ICT) drainage for 6 days. There were four patients with fibrinopurulent empyema treated with thoracoscopic drainage with a mean post-operative stay of 8 days (range 4-12 days). In the organizing stage (n=18), initial drainage with large ICT was performed. The pleura was less than 2 cm in thickness in eight patients, for which repeated installation of streptokinase was performed (three to seven times). Satisfactory results were achieved in six patients (75%) and the remaining two required decortication. Of the ten patients with thick cortex, one required a window and nine had decortication, two of which had additional lobectomy and two had pneumonectomy. All patients fully recovered with no mortality and with a mean duration of drainage of 18 days (range 3-61 days).
Its stage and the state of the underlying lung should guide surgical treatment for tuberculous empyema. This protocol aims to achieve cure utilizing the least invasive approach and acceptable hospital stay.
为建立结核性脓胸的治疗方案，我们回顾了3年期间的经验。
1996年1月至1998年12月，26例（23例男性，3例女性）平均年龄33.8岁（范围18 - 61岁）的患者出现结核性脓胸。脓胸位于右侧13例，左侧12例，双侧1例。患者出现呼吸道症状的平均持续时间为4.43个月（范围1 - 48个月）。所有患者均进行了胸部计算机扫描，并根据脓胸阶段进行处理。
在渗出性脓胸患者（n = 4）中，进行了胸腔穿刺抽液，但1例患者需要肋间置管（ICT）引流6天。4例纤维脓性脓胸患者接受了胸腔镜引流治疗，术后平均住院时间为8天（范围4 - 12天）。在机化期（n = 18），最初采用大口径ICT进行引流。8例患者胸膜厚度小于2cm，对其进行了链激酶的反复注入（3至7次）。6例患者（75%）取得了满意的结果，其余2例需要行胸膜剥脱术。在10例胸膜增厚的患者中，1例需要开窗术，9例需要行胸膜剥脱术，其中2例还进行了肺叶切除术，2例进行了肺切除术。所有患者均完全康复，无死亡病例，平均引流时间为18天（范围3 - 61天）。
结核性脓胸的手术治疗应根据其阶段和基础肺的状态来指导。该方案旨在采用创伤最小的方法并在可接受的住院时间内实现治愈。
