Yamaguchi Masafumi, Takeo Sadanori, Suemitsu Ryuichi, Matsuzawa Hironori, Okazaki Hiroshi
Division of General Thoracic Surgery, Respiratory Center and Clinical Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Ann Thorac Cardiovasc Surg. 2009 Dec;15(6):368-72.
Thoracic empyema remains a serious problem.
We evaluated the feasibility and efficacy of video-assisted thoracic surgery (VATS) for fibropurulent thoracic empyema.
Twenty-six consecutive patients with thoracic empyema resistant to medical therapy were treated by VATS from 1997 to 2006. The presence of pleural adhesion was not a contraindication. Patients with destroyed lung, bronchopleural fistula, or excessively thickened pleura were excluded.
Twenty-two were males and 4 were females with a mean age of 59 years (range 14 to 85). The length of preoperative period was 39.3 +/- 25.3 days, and the length of preoperative treatment was 11.2 +/- 14.3 days. The operating time was 127.6 +/- 45.1 minutes and intraoperative bleeding was 353.8 +/- 438.4 g. Postoperative complications were observed in two cases (8.0%). There were no hospital deaths. Twenty-two cases (84.6%) were cured with a postoperative drainage time of 12.5 +/- 8.2 days. Four cases required an additional operation. However, the VATS procedure was not required to perform additional thoracoplasty using pedicled chest wall muscles.
VATS for fibropurulent thoracic empyema is effective and less invasive, and it may be important as a bridge between minimally invasive and conventional open thoracic surgical management.
脓胸仍然是一个严重的问题。
我们评估了电视辅助胸腔镜手术（VATS）治疗纤维脓性脓胸的可行性和疗效。
1997年至2006年，26例内科治疗无效的脓胸患者接受了VATS治疗。胸膜粘连的存在并非禁忌证。排除肺毁损、支气管胸膜瘘或胸膜过度增厚的患者。
男性22例，女性4例，平均年龄59岁（14至85岁）。术前病程为39.3±25.3天，术前治疗时间为11.2±14.3天。手术时间为127.6±45.1分钟，术中出血353.8±438.4克。观察到2例（8.0%）术后并发症。无医院死亡病例。22例（84.6%）治愈，术后引流时间为12.5±8.2天。4例需要再次手术。然而，VATS手术不需要使用带蒂胸壁肌肉进行额外的胸廓成形术。
VATS治疗纤维脓性脓胸有效且创伤小，作为微创与传统开胸手术治疗之间的桥梁可能具有重要意义。
