Schneiter Didier, Kestenholz Peter, Dutly André, Korom Stephan, Giger Urs, Lardinois Didier, Weder Walter
Department of Surgery, Division of Thoracic Surgery, University Hospital, 8091 Zurich, Switzerland.
Eur J Cardiothorac Surg. 2002 Apr;21(4):644-8. doi: 10.1016/s1010-7940(02)00043-x.
Pneumonectomy in chronic pulmonary infection with empyema is associated with a high mortality rate and an increased risk of recurrent empyema. The surgical resection is technically demanding, and successful management continues to be a challenge.
We evaluated a concept which combines (pleuro-)pneumonectomy or completion pneumonectomy with surgical debridement of the pleural cavity and packing with povidine-iodine soaked dressings. The debridement and packing is repeated in the operating theater after 48 h until the chest cavity is macroscopically clean. Finally, the pleural space is obliterated with antibiotic solution.
Between February 1997 and October 2000, 11 patients (average age of 59 years, ranging from 25 to 84) with destroyed lung caused by tuberculosis (six), aspergilloma (two), bronchiectasis (one), esophago-pleural fistula (one) or broncho-pleural fistula after lobectomy for bronchial carcinoma (one) and ongoing chronic infection with acute empyema (ten) (25-2500 days between first and definitive therapy) were treated. Pleural culture findings showed Aspergillus in four, Mycobacterium in two, Enterococcus in two, Candida in one and Staphylococcus in one, respectively. The mean number of interventions was 2.9 (2-4). The chest was definitively closed in all patients within 1 week. The mean hospitalization time was 19 days (9-31 days). In the follow-up (10-54 months), there was no recurrence of empyema. One patient (84 years) died at day 31, due to sepsis.
Pneumonectomy combined with repeated surgical debridement and antimicrobial therapy enables the successful treatment of chronic pulmonary infection with empyema within a short time period.
慢性肺部感染合并脓胸行肺切除术死亡率高，脓胸复发风险增加。手术切除技术要求高，成功治疗仍是一项挑战。
我们评估了一种概念，即将（胸膜）肺切除术或全肺切除术与胸膜腔手术清创及用聚维酮碘浸泡敷料填塞相结合。48小时后在手术室重复清创和填塞，直至胸腔在肉眼下清洁。最后，用抗生素溶液封闭胸膜腔。
1997年2月至2000年10月，11例患者（平均年龄59岁，范围25至84岁）因肺结核（6例）、曲霉菌球（2例）、支气管扩张（1例）、食管胸膜瘘（1例）或支气管肺癌肺叶切除术后支气管胸膜瘘（1例）导致肺毁损，伴有持续慢性感染及急性脓胸（10例）（首次治疗与最终治疗间隔25至2500天）接受了治疗。胸膜培养结果分别显示曲霉菌4例、分枝杆菌2例、肠球菌2例、念珠菌1例和葡萄球菌1例。平均干预次数为2.9次（2至4次）。所有患者均在1周内最终关闭胸腔。平均住院时间为19天（9至31天）。随访（10至54个月）期间，无脓胸复发。1例患者（84岁）于第31天死于败血症。
肺切除术联合重复手术清创及抗菌治疗能够在短时间内成功治疗慢性肺部感染合并脓胸。
