Carrillo Eddy H, Barkoe David J, Sanchez Rafael, Lee Seong K, Rosenthal Andrew, Pepe Antonio, Nardiello Dawn
Division of Trauma Services, Memorial Regional Hospital, 3501 Johnson Street, Hollywood, FL 33021, USA.
Am Surg. 2009 Feb;75(2):152-6.
Historically, tube thoracostomy, image-guided drainage, or an open thoracotomy has been indicated as the standard procedure for the management of patients with retained infected pleural collections (RIPC). These infections can be a debilitating and potentially lethal complication in already critically ill trauma patients. The purpose of this review was to evaluate the usefulness of an open thoracic window (OTW) as definitive therapy for the management of RIPC refractory to conventional therapies. The medical records of patients who underwent an OTW for RIPC were reviewed for the following: demographic data, primary diagnosis, clinical findings that explained the failure of the conventional management, bacteriology of the retained collection, and final outcome. Over a 3-year period, eight critically ill trauma patients who had sustained multiple system trauma and developed a RIPC were identified (six males and two females; average age, 47 years). Of the eight patients identified, six collections were in the right and two in the left pleural cavity. Staphylococcus aureus and Acinetobacter were the two most common bacterial isolates from these collections. All patients had undergone multiple and unsuccessful drainage attempts by thoracostomy tubes. Additionally, two of the patients also underwent image-guided drainage procedures, which proved to be unsuccessful. After creation of the OTW, all patients had complete resolution of the RIPC, and all were discharged alive from the hospital. During outpatient follow up, the OTW was found to have completely healed and required no further surgical intervention. The creation of long-term pleural drainage, with an OTW, facilitates and expedites the resolution of persistent infected pleural collections by providing more efficient surgical drainage and mechanical débridement. Our experience also shows this uncommon operation to be an effective alternative when conventional measures have failed.
从历史上看，胸腔闭式引流、影像引导下引流或开胸手术一直被视为处理留置感染性胸腔积液（RIPC）患者的标准方法。这些感染对于本就危重症的创伤患者而言，可能是一种使人虚弱且有潜在致命风险的并发症。本综述的目的是评估开放胸廓造口术（OTW）作为对传统治疗无效的RIPC的确定性治疗方法的有效性。对因RIPC接受OTW治疗的患者的病历进行了如下回顾：人口统计学数据、初步诊断、解释传统治疗失败的临床发现、留置积液的细菌学情况以及最终结局。在3年期间，确定了8例遭受多系统创伤并发生RIPC的危重症创伤患者（6例男性和2例女性；平均年龄47岁）。在确定的8例患者中，6处积液位于右侧胸腔，2处位于左侧胸腔。金黄色葡萄球菌和不动杆菌是这些积液中最常见的两种分离细菌。所有患者均多次通过胸腔闭式引流管进行引流但未成功。此外，其中2例患者还接受了影像引导下引流术，但也未成功。在创建OTW后，所有患者的RIPC均完全消退，且均康复出院。在门诊随访期间，发现OTW已完全愈合，无需进一步手术干预。通过OTW建立长期胸腔引流，通过提供更有效的手术引流和机械清创，促进并加速了持续性感染性胸腔积液的消退。我们的经验还表明，当传统措施失败时，这种不常见的手术是一种有效的替代方法。
