Pilav Ilijaz, Guska Safet, Musanovic Safet, Kadric Kenan
Clinic of Thoracic Surgery, Clinical Center of Sarajevo University, Bosnia and Herzegovina.
Med Arh. 2009;63(5):291-4.
Para pneumonic effusions are often complications of bacterial pneumonia, occurring in 5-50% patients and in 15% cases it can progress into pleural empyema. Pleural empyema treatment includes drainage of pus, re-expansion of lung by using appropriate antibiotics. Surgical treatment covers implementation of certain thoracic drainage modifications, use of VATS techniques and thoracotomy with pleura decortications.
Research has involved 100 patients with diagnosis and treatment of para pneumonic and meta pneumonic pleural empyema.
Based on previously defined phase of pleural empyema it was determined which surgical procedures have been used in definitive treatment of pleural empyema. In case of 31,17% (24/77) patients it has been found that pre-clinical treatment lasted 31 days and longer, and 49,35% (38/77) patients have been admitted at Clinic after 11 to 30 days of pre-clinic treatment. Only in 19.48% (15/77) patients pre-clinic treatment lasted up to 10 days. 79% (79/100) patients were in third phase of disease, 19% (19/100) patients were in second phase and 2% (2/100) patients were in first stage of disease. Among patients with first stage of disease 1 patient was subject to pleural drainage and 1 was subject to decortications. Among patients with second phase of disease 10 patients were subject to pleural drainage and 9 to decortications. Among patients with third phase of disease 20 patients were subject to pleural drainage and 49 to decortications, 4 patients were subject to pleural drainage with rib resection, and 2 were subject to combination of thoracoscopy and drainage, while in case of 4 patients it was necessary to perform additional drainage.
Pleural drainage is first procedure in surgical treatment of pleural empyema, but very often it is not definitive measure of treatment of patients with third phase of disease. Definitive treatment of empyema in third phase is decortications of pleura carried out on 62% patients with this phase of disease. Efficiency of treatment determined on basis of mortality level is satisfactory.
类肺炎性胸腔积液通常是细菌性肺炎的并发症，发生率为5% - 50%的患者，其中15%的病例可能进展为胸膜脓胸。胸膜脓胸的治疗包括脓液引流，使用适当抗生素使肺复张。手术治疗包括实施某些胸腔引流改良术、使用电视辅助胸腔镜手术（VATS）技术以及胸膜纤维板剥脱术的开胸手术。
研究纳入了100例诊断和治疗类肺炎性及肺炎旁性胸膜脓胸的患者。
根据先前定义的胸膜脓胸阶段，确定了在胸膜脓胸的确定性治疗中使用了哪些手术程序。在31.17%（24/77）的患者中，发现临床前治疗持续31天及更长时间，49.35%（38/77）的患者在临床前治疗11至30天后入住诊所。只有19.48%（15/77）的患者临床前治疗持续至10天。79%（79/100）的患者处于疾病第三阶段，19%（19/100）的患者处于第二阶段，2%（2/100）的患者处于疾病第一阶段。在疾病第一阶段的患者中，1例接受了胸腔引流，1例接受了纤维板剥脱术。在疾病第二阶段的患者中，10例接受了胸腔引流，9例接受了纤维板剥脱术。在疾病第三阶段的患者中，20例接受了胸腔引流，49例接受了纤维板剥脱术，4例接受了肋骨切除的胸腔引流，2例接受了胸腔镜检查与引流联合治疗，而在4例患者中需要进行额外引流。
胸腔引流是胸膜脓胸手术治疗的首要程序，但对于疾病第三阶段的患者，它往往不是确定性的治疗措施。疾病第三阶段脓胸的确定性治疗是对62%处于该阶段疾病的患者进行胸膜纤维板剥脱术。基于死亡率确定的治疗效果是令人满意的。
