Bar Ilan, Stav David, Fink Gershon, Peer Amir, Lazarovitch Tsilia, Papiashvilli Michael
Assaf Harofeh Medical Center, Zerifin, Israel.
Asian Cardiovasc Thorac Ann. 2010 Aug;18(4):337-43. doi: 10.1177/0218492310375752.
We retrospectively analyzed the data of 119 patients who were treated for empyema thoracis from 1999 to 2007. There were 87 men with a mean age of 63.9 years (range, 19-79 years) and 32 women with a mean age 55.2 years (range, 26-78 years). The empyema was right-sided in 73 patients and left-sided in 46. The etiology was parapneumonic in 43.7% of cases, postoperative in 42.0%, posttraumatic in 11.8%, and due to other causes in 2.5%. Eight (6.7%) patients underwent surgery on admission because of unstable clinical status; all 8 survived. Fibrinolysis was used in 111 (93.3%) patients; of these, 88 (73.9%) were successfully treated by intrapleural urokinase instillation, and 23 (19.4%) failed treatment and underwent surgery. All 88 patients who had successful fibrinolytic therapy survived, they accounted for 1.8% of the morbidity. In the 23 patients who underwent surgery after failed treatment, there were 3 deaths, accounting for 2.7% overall mortality and 6.3% morbidity. Treating thoracic empyema in patients with significant comorbidities is challenging. Intrapleural urokinase administration might be beneficial in high-risk patients, but in those without significant comorbidities, early surgery may be considered.
我们回顾性分析了1999年至2007年期间接受脓胸治疗的119例患者的数据。其中男性87例，平均年龄63.9岁（范围19 - 79岁）；女性32例，平均年龄55.2岁（范围26 - 78岁）。脓胸位于右侧的患者有73例，左侧有46例。病因方面，肺炎旁性占43.7%，术后占42.0%，创伤后占11.8%，其他原因占2.5%。8例（6.7%）患者因临床状况不稳定在入院时接受了手术，全部存活。111例（93.3%）患者使用了纤维蛋白溶解疗法；其中，88例（73.9%）通过胸腔内注入尿激酶成功治疗，23例（19.4%）治疗失败并接受了手术。所有88例纤维蛋白溶解疗法成功的患者均存活，占发病率的1.8%。在治疗失败后接受手术的23例患者中，有3例死亡，占总死亡率的2.7%和发病率的6.3%。治疗合并严重基础疾病的脓胸患者具有挑战性。对于高危患者，胸腔内注入尿激酶可能有益，但对于无严重基础疾病的患者，可考虑早期手术。
