Klopp M, Dienemann H
Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum Heidelberg.
Dtsch Med Wochenschr. 2005 Mar 11;130(10):530-3. doi: 10.1055/s-2005-863087.
Pleural empyema runs in three stages, if untreated. Because it produces uncharacteristic signs, specific diagnosis and adequate treatment is often delayed. The treatment should be early, according to the stage and adapted to the given situation. Expenditure and morbidity of treatment are the higher the longer it is delayed. In the exudative stage 1, drainage--if necessary combined with antibiotic administration--is likely to be successful. In the fibrinous-purulent stage 3, often not clearly demarked from the other stages, video-assisted thoracoscopy (VATS) in its various forms provides the best therapeutic prerequisite. It makes it possible to open all cavities and free pleural layers from the, usually fibrinous or fibrosing, contents. Furthermore, VATS allows targeted drainage placement as essential precondition of effective irrigation. The definitive stage 3 of organization requires the technically demanding empyema excision or decortication.
如果不进行治疗，胸膜积脓会经历三个阶段。由于其症状不典型，往往会导致特异性诊断和充分治疗的延迟。治疗应尽早进行，根据阶段并结合具体情况进行调整。治疗延迟的时间越长，费用和发病率就越高。在渗出期1，如有必要，引流结合抗生素给药可能会成功。在纤维蛋白化脓期3，通常与其他阶段没有明显界限，各种形式的电视辅助胸腔镜手术（VATS）提供了最佳的治疗前提条件。它能够打开所有腔隙，并清除胸膜层上通常为纤维蛋白性或纤维化的内容物。此外，VATS允许有针对性地放置引流管，这是有效冲洗的必要前提。机化的终末期3需要技术要求较高的脓胸切除或胸膜剥脱术。
