Campobasso P, D'Agostino S, Belloli G
Divisione di Chirurgia Pediatrica, Ospedale Regionale di Vicenza, Italia.
Pediatr Med Chir. 1991 Jul-Aug;13(4):423-6.
Antibiotics and pleural drainage with continuous suction is effective in treatment of childhood pleural empyema. However a recognizable number of childhood pleural empyema fail to improve or to cure after this treatment. This study reviews our experience with 27 children over past 8 years. All patients were treated with antibiotics, seven with only pleural drainage, twenty with pulmonary decortication. Indications for decortication were: clinical and radiological failure after 4-5 days of treatment with pleural drainage and continuous suction; persistent fever; persistent respiratory distress; persistent signs of general illness; persistent loculated pleural effusions; worsening parenchymal disease. The clinical and radiological improvements following decortication were dramatic with immediate lung reexpansion and improvement of clinical course. The chest tubes were removed by the fifth postoperative day and the children were discharged by the seventh-nine postoperative day. There were no complications and no deaths. In our experience pulmonary decortication is a simple and effective treatment of childhood empyema in the advanced fibro-purulent and/or early organizing phase with immediate and long-term excellent results.
抗生素联合持续吸引的胸腔引流术对儿童胸腔积脓的治疗有效。然而，有相当数量的儿童胸腔积脓在这种治疗后未能改善或治愈。本研究回顾了我们在过去8年中对27例儿童的治疗经验。所有患者均接受了抗生素治疗，7例仅行胸腔引流，20例行肺剥脱术。剥脱术的指征为：胸腔引流和持续吸引治疗4 - 5天后临床和影像学表现无改善；持续发热；持续呼吸窘迫；全身疾病的持续体征；持续的包裹性胸腔积液；实质性疾病恶化。剥脱术后临床和影像学改善显著，肺立即复张，临床病程改善。术后第5天拔除胸管，术后第7 - 9天患儿出院。无并发症及死亡病例。根据我们的经验，肺剥脱术是治疗晚期纤维脓性和/或早期机化期儿童脓胸的一种简单有效的方法，能立即取得良好的长期效果。
