Klopp M, Pfannschmidt J, Dienemann H
Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum, Amalienstrasse 5, 69126, Heidelberg, Germany.
Chirurg. 2008 Jan;79(1):83-94; quiz 95-6. doi: 10.1007/s00104-007-1429-y.
Pleural empyema remains a frequently encountered clinical problem and is responsible for significant morbidity and mortality worldwide. Its diagnosis may be difficult; delays in diagnosis and treatment may contribute to morbidity, complications, and mortality. The management of parapneumonic effusion and empyema depends on timely, stage-dependent therapy and the underlying etiology. Thoracentesis and antibiotics remain the cornerstones of treatment in stage I disease. In the early fibrinopurulent phase (stage II) thoracoscopic methods should be considered. As treatment strategy for this stage, fibrinopurulent pleural empyema entails thorough debridement of multiloculated collections from the pleural cavity by video-assisted thoracic surgery. After evacuation of multilocular effusions and the removal of fibrin deposits with drainage by two intercostal chest tubes, irrigation treatment helps to achieve clarity of the pleural discharge. Open thoracotomy and decortication are reserved for organized, multiloculated empyema with lung entrapment (stage III disease). Early drain removal may lead to rapid symptomatic recovery and complete resolution.
胸腔积脓仍然是一个常见的临床问题，在全球范围内导致了显著的发病率和死亡率。其诊断可能困难；诊断和治疗的延迟可能导致发病率、并发症和死亡率增加。肺炎旁胸腔积液和胸腔积脓的治疗取决于及时、分阶段的治疗以及潜在病因。胸腔穿刺术和抗生素仍然是I期疾病治疗的基石。在早期纤维脓性阶段（II期），应考虑采用胸腔镜方法。作为该阶段的治疗策略，纤维脓性胸腔积脓需要通过电视辅助胸腔手术对胸腔内的多房性积液进行彻底清创。在通过两根肋间胸管引流清除多房性积液并清除纤维蛋白沉积物后，冲洗治疗有助于使胸腔引流液变清。开胸手术和胸膜剥脱术适用于伴有肺陷闭的机化性、多房性胸腔积脓（III期疾病）。早期拔除引流管可能导致症状迅速缓解并完全消退。
