Ozel S Kerem, Kazez Ahmet, Kilic Mehmet, Koseogullari A Aysel, Yilmaz Erdal, Aygun A Denizmen
Department of Pediatric Surgery, Faculty of Medicine, Firat University, 23119 Elazig, Turkey.
Surg Today. 2004;34(12):1002-5. doi: 10.1007/s00595-004-2859-5.
Many treatment modalities have been described for thoracic empyema in children but the optimal timing of appropriate treatment remains controversial. The aim of this study is to find out the outcome of postpneumonic empyema in children after a conservative approach.
The reports of patients who were admitted to our hospital from January 1990 to October 2002 with a diagnosis of postpneumonic thoracic empyema were reviewed retrospectively. The comparative data were age, duration of prehospital illness, complaints, blood and pleural fluid analyses, radiological evaluations, microbiological studies, modes of treatment, duration of chest tube drainage, and length of hospital stay.
A total of 115 patients (65 males and 50 females), aged from 3 months to 13 years, were evaluated. The most common symptoms were fever (96.5%), cough (85.2%), and dyspnea (50.4%). Chest X-rays revealed a minimal collection in 22 (19.2%), a moderate collection in 40 (34.8%), and a massive collection in 53 patients (46%). Staphylococcus aureus was the most common microorganism isolated from the bacterial cultures and Mycobacterium tuberculosis was the next most common. Twelve patients (10.4%) underwent surgical decortication. The mean duration of chest drainage was 10.1 +/- 1.39 days. The mean hospitalization period was 24.2 +/- 6.15 days and it was significantly shorter in patients with a minimal collection than in those with a massive collection (13.9 +/- 2.21 vs 28.47 +/- 6.38 days, P < 0.01).
The majority of postpneumonic thoracic empyema cases in children can be successfully treated with a conservative approach. Detailed investigations should also be done to rule out tuberculosis in these patients.
针对儿童胸腔积脓已有多种治疗方式被描述，但恰当治疗的最佳时机仍存在争议。本研究的目的是找出采用保守治疗方法后儿童肺炎后脓胸的治疗结果。
回顾性分析1990年1月至2002年10月期间因肺炎后胸腔积脓诊断而入住我院患者的报告。比较的数据包括年龄、院前疾病持续时间、症状、血液和胸腔积液分析、影像学评估、微生物学研究、治疗方式、胸腔闭式引流持续时间及住院时间。
共评估了115例患者（65例男性和50例女性），年龄从3个月至13岁。最常见的症状为发热（96.5%）、咳嗽（85.2%）和呼吸困难（50.4%）。胸部X线显示少量积液22例（19.2%）、中等量积液40例（34.8%）、大量积液53例（46%）。金黄色葡萄球菌是细菌培养中分离出的最常见微生物，其次是结核分枝杆菌。12例患者（10.4%）接受了手术剥脱术。胸腔引流的平均持续时间为10.1±1.39天。平均住院时间为24.2±6.15天，少量积液患者的住院时间明显短于大量积液患者（13.9±2.21天对28.47±6.38天，P<0.01）。
儿童肺炎后胸腔积脓的大多数病例可通过保守治疗成功治愈。还应进行详细检查以排除这些患者中的结核病。
