Tassi G F, Marchetti G P, Pinelli V, Chiari S
Divisione di Pneumologia, Spedali Civili di Brescia, Brescia, Italy.
Monaldi Arch Chest Dis. 2010 Sep;73(3):124-9. doi: 10.4081/monaldi.2010.296.
Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although the majority of cases are post-bacterial pneumonia. Despite treatment with antibiotics, patients with empyema have a considerable morbidity and mortality due at least in part to inappropriate management of the effusion. Timely diagnosis of pleural space infection and rapid initiation of effective pleural drainage represent fundamental principles for managing patients with empyema. Ultrasound is particularly useful to identify early fibrin membranes and septations in the pleural cavity conditioning treatment strategy. Empyema and large or loculated effusion with a pH < 7.20 need to be drained. Thoracoscopy has largely been used in pleural effusion due to lung infection. Whereas the efficacy of video-assisted thoracic surgery (VATS) in empyema management has been evaluated in several retrospective studies showing favourable results, less is known about the role of medical thoracoscopy (MT) in pleural infection. MT, appears to be safe and successful in multiloculated empyema treatment. It is also lower in cost and in frail patients is better tolerated than VATS which requires tracheal intubation.
脓胸是指由于胸膜腔感染导致胸腔内有脓液，其潜在病因是多因素的，尽管大多数病例继发于细菌性肺炎。尽管使用了抗生素治疗，但脓胸患者仍有相当高的发病率和死亡率，至少部分原因是对胸腔积液处理不当。及时诊断胸膜腔感染并迅速开始有效的胸腔引流是治疗脓胸患者的基本原则。超声对于识别胸腔内早期的纤维蛋白膜和分隔特别有用，这有助于确定治疗策略。脓胸以及pH<7.20的大量或局限性胸腔积液需要进行引流。胸腔镜检查在肺部感染所致胸腔积液中应用广泛。虽然在多项回顾性研究中评估了电视辅助胸腔镜手术（VATS）在脓胸治疗中的疗效，结果显示效果良好，但关于内科胸腔镜检查（MT）在胸膜感染中的作用了解较少。MT在多房性脓胸治疗中似乎是安全且成功的。它成本较低，对于体弱患者，其耐受性比需要气管插管的VATS更好。
