Zaheer Salman, Allen Mark S, Cassivi Stephen D, Nichols Francis C, Johnson Craig H, Deschamps Claude, Pairolero Peter C
Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2006 Jul;82(1):279-86; discussion 286-7. doi: 10.1016/j.athoracsur.2006.01.052.
The purpose of this study was to analyze our experience with the management of patients with postpneumonectomy empyema treated by the Clagett procedure.
Data were analyzed from our prospective database on 84 consecutive patients with postpneumonectomy empyema from July 1988 to June 2004.
There were 73 men and 11 women. Median age was 62 years (range, 35 to 77). Indications for pneumonectomy were malignancy in 77 patients and benign disease in 7. The pneumonectomy was done at our institution in 43 patients and elsewhere in 41. A right pneumonectomy was performed in 66 patients and a left in 18. All patients were managed with the Clagett procedure consisting of open pleural drainage, serial operative debridements, and eventual chest closure after filling the pleural cavity with antibiotic solution. A bronchopleural fistula was present in 55 patients and was closed in all. A muscle flap was used to reinforce the bronchial stump in 60 patients (71%), 51 with a bronchopleural fistula, and 9 without. Operative mortality was 7.1%. Median follow-up was 1.5 years (range, 0 to 22). Overall, 81% of patients had a healed chest wall without evidence of recurrent infection. The bronchopleural fistula remained closed in all patients. Median overall survival was 3.4 years with a 5-year survival of 44.5%. Age less than 65 years and an interval between pneumonectomy and empyema of greater than 15 weeks were independent predictors of improved long-term survival.
The Clagett procedure remains safe and successful in the majority of patients with postpneumonectomy empyema. Age less than 65 years and a long interval between pneumonectomy and empyema are important determinants of outcome.
本研究的目的是分析我们采用克拉吉特手术治疗肺切除术后脓胸患者的经验。
分析了我们前瞻性数据库中1988年7月至2004年6月连续84例肺切除术后脓胸患者的数据。
男性73例，女性11例。中位年龄为62岁（范围35至77岁）。肺切除的指征为恶性肿瘤77例，良性疾病7例。43例患者在我们机构进行了肺切除术，41例在其他地方进行。66例患者行右肺切除术，18例患者行左肺切除术。所有患者均采用克拉吉特手术，包括开放胸腔引流、系列手术清创，以及在胸腔内注入抗生素溶液后最终关闭胸腔。55例患者存在支气管胸膜瘘，均已闭合。60例患者（71%）使用肌瓣加强支气管残端，其中51例有支气管胸膜瘘，9例无。手术死亡率为7.1%。中位随访时间为1.5年（范围0至22年）。总体而言，81%的患者胸壁愈合，无复发感染迹象。所有患者的支气管胸膜瘘均保持闭合。中位总生存期为3.4年，5年生存率为44.5%。年龄小于65岁以及肺切除与脓胸之间的间隔大于15周是长期生存改善的独立预测因素。
克拉吉特手术在大多数肺切除术后脓胸患者中仍然安全且成功。年龄小于65岁以及肺切除与脓胸之间的间隔时间长是预后的重要决定因素。
