Furuya-Meguro M E, Mejía-Aranguré J M, Martínez-Martínez B E, Villalpando-Canchola R, Fuentes-Arellano S A
División de Especialidades Médicas, Hospital de Pediatría, Centro Médico Nacional Siglo XXI IMSS, México D.F.
Gac Med Mex. 2000 Sep-Oct;136(5):449-54.
The precise indication for surgery for pleural empyema is still a controversy. With the aim of identifying the risk factors associated with surgery in pediatric patients with empyema post-pneumonia, a retrospective case control study was performed. From 1992 to 1996, 18 children underwent surgery (cases) and 12 did not (controls). The analyzed variables were those mentioned in the literature as risk factors. More than 25 days of evolution, more than three antibiotic schemes, fever, empyema organizing phase, two or more chest tubes lasting more than nine days, multiple loculations, trapped lung and paquipleura were associated with thoracostomy and decortication (p < 0.05). We conclude that a pediatric patient with a late referral to the hospital, empyema organizing phase, and multiple loculations with large purulent collections no longer susceptible to drainage and complications that impair lung expansion will probably require major surgery.
胸膜脓胸手术的确切指征仍是一个有争议的问题。为了确定肺炎后脓胸患儿手术的相关危险因素，进行了一项回顾性病例对照研究。1992年至1996年，18名儿童接受了手术（病例组），12名儿童未接受手术（对照组）。分析的变量是文献中提到的作为危险因素的那些变量。病程超过25天、使用三种以上抗生素方案、发热、脓胸机化期、两根或更多胸管留置超过九天、多房性、肺萎陷和胸膜增厚与开胸引流和剥脱术相关（p<0.05）。我们得出结论，对于转诊至医院较晚、处于脓胸机化期、有多房性且有大量脓性积液且不再适合引流以及存在影响肺扩张的并发症的小儿患者，可能需要进行大手术。
