Kadoyama Chikabumi, Ishikawa Aki, Shiba Mitsutoshi, Yasufuku Kazuhiro, Hoshino Hidehisa, Suwa Toshikazu, Fujisawa Takehiko
Department of Thoracic Surgery, Saitama Red Cross Hospital, Saitama, Japan.
Jpn J Thorac Cardiovasc Surg. 2003 Sep;51(9):413-9. doi: 10.1007/BF02719593.
Failure or prolongation of treatment for refractory thoracic empyema by the current chest-tube drainage technique is often due to sterilization difficulties. Insufficient sterilization prolongs hospitalization, and is often associated with life-threatening complications and/or additional invasive surgical procedures. A new chest-tube sterilization technique aimed at making it less invasive and shortening the therapy is proposed.
Following pretreatment for complications including loculation, bronchopleural fistula, or corticated lung, a double-lumen trocar catheter was introduced at the bottom of the empyemic cavity through the lateral chest wall. Then, a Foley balloon urethra-catheter was inserted and attached just inside the anterior chest wall at the top of the cavity for the evacuation of intrathoracic air. After irrigation of the cavity with distilled water once or twice, the cavity was completely filled with a bactericidal solution which was left in place for 30-60 minutes, followed by an antibiotic solution for more than 20 hours.
Among the five treated post-lobectomy or pneumonectomy cases, sterilization was obtained after only one treatment in four cases and after two courses in the other. Catheterization duration from the initial treatment was 2-13 days. Neither recurrence nor treatment-related major complications were observed.
This balloon-tube thoracostomy technique is simple, minimally invasive and cost-effective, due to shortening of the treatment time with minimal manpower and equipment requirements. It is thus a promising therapeutic approach to thoracic empyema and has the potential for application to other intrathoracic disorders.
目前胸腔闭式引流技术治疗难治性胸腔积脓失败或治疗时间延长，通常是由于灭菌困难。灭菌不充分会延长住院时间，且常伴有危及生命的并发症和/或额外的侵入性外科手术。本文提出一种新的胸腔闭式引流管灭菌技术，旨在减少侵入性并缩短治疗时间。
在对包括包裹性积液、支气管胸膜瘘或肺皮质化等并发症进行预处理后，通过侧胸壁在脓腔底部插入双腔套管针导管。然后，插入一根Foley气囊导尿管并固定在脓腔顶部前胸壁内侧，用于排出胸腔内气体。用蒸馏水冲洗脓腔一到两次后，将脓腔完全充满杀菌溶液并留置30 - 60分钟，随后注入抗生素溶液超过20小时。
在五例肺叶切除或肺切除术后接受治疗的病例中，四例仅经过一次治疗即实现灭菌，另一例经过两个疗程实现灭菌。从初次治疗开始的置管时间为2 - 13天。未观察到复发或与治疗相关的主要并发症。
这种气囊管胸腔造口术技术简单、微创且具有成本效益，因为它缩短了治疗时间，对人力和设备的要求最低。因此，它是一种有前景的胸腔积脓治疗方法，并且有可能应用于其他胸腔内疾病。
