Lauschke H, Decker P, Baldacci A, Rudolph J, Hirner A
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Rheinischen Friedrich-Wilhelms-Universität Bonn.
Zentralbl Chir. 2001 Sep;126(9):696-701. doi: 10.1055/s-2001-18248.
Up till now the phases adapted treatment of a pleural empyema unfortunately is still not obvious, but recently the operative spectrum has been widened in the field of video-assisted thoracoscopic surgery (VATS) of the pleural empyema.
In the present study we examined all our patients with a pleural empyema and we followed them for a postoperative period of 4 years analysing our therapy-efficacy and our treatment concept of pleural empyema.
52 out of 102 patients--who suffered from a pleural empyema in the last 10 years--were reexamined postoperatively. In 96% of the 102 cases we found a phase II-III empyema. Initially all patients were treated with a closed-chest-tube drainage, followed by an operation in 78%. In 6 cases a video-assisted-thoracoscopic evacuation of the cavity with an early decortication was performed. All the 52 patients who were treated in an early phase showed the best functional results 4 years later.
Especially in phase III the open operative revision of a pleural empyema is the method of choice. In the fibrinopurulent phase the drainage therapy may be sufficient. If the empyema cavity is divided we recommend the early video-assisted-thoracoscopic revision of the thoracic empyema.
遗憾的是，迄今为止，胸膜腔积脓的阶段性适应性治疗仍不明确，但最近在胸膜腔积脓的电视辅助胸腔镜手术（VATS）领域，手术范围有所扩大。
在本研究中，我们对所有胸膜腔积脓患者进行了检查，并在术后4年对他们进行随访，分析我们对胸膜腔积脓的治疗效果和治疗理念。
在过去10年中患有胸膜腔积脓的102例患者中，52例在术后接受了复查。在102例病例中的96%，我们发现为Ⅱ-Ⅲ期脓胸。最初，所有患者均接受闭式胸腔引流管引流治疗，随后78%的患者接受了手术。6例患者进行了电视辅助胸腔镜下脓腔清除并早期剥脱术。所有在早期接受治疗的52例患者在4年后均显示出最佳的功能结果。
特别是在Ⅲ期，胸膜腔积脓的开放性手术翻修是首选方法。在纤维脓性期，引流治疗可能就足够了。如果脓腔分隔，我们建议早期进行电视辅助胸腔镜下胸膜腔积脓翻修术。
