Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
World J Surg. 2011 May;35(5):981-4. doi: 10.1007/s00268-011-1035-5.
Thoracic empyema is a collection of pus in the pleural space. Empyema necessitatis is a rare complication of empyema, characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. We present nine cases of empyema necessitatis, including etiology, duration, and characteristics of clinical history, kind of surgery used, and treatment choices.
In a 4-year period nine patients were treated for empyema necessitatis. Six were male and 3 female with an age range of 13-89 years (median=40 years).
Empyema necessitatis was treated with drainage and antibiotherapy or antituberculosis therapy in three patients with the diagnosis of tuberculosis or nonspecific pleuritis. Decortication of the thoracic cavity was used in three patients successfully. Others were treated with open drainage. Final diagnoses were tuberculous empyema in five patients, chronic fibrinous pleuritis in three, and squamous cell carcinoma in one. Except for two patients, one with multisystem failure and one with squamous cell carcinoma, all were discharged with no complications.
Surgery plays a critical role in the management of empyema necessitatis in selected patients. Tube drainage, open drainage, and decortication are the choices in variable conditions for obliterating the cavity and regenerating pulmonary function.
脓胸是胸腔内脓液的积聚。化脓性胸膜炎是脓胸的一种罕见并发症，其特征为脓液通过胸壁软组织并最终通过皮肤穿透。我们报告了 9 例化脓性胸膜炎病例，包括病因、病程和临床病史特点、手术类型以及治疗选择。
在 4 年期间，有 9 例患者因化脓性胸膜炎接受了治疗。其中 6 例为男性，3 例为女性，年龄 13-89 岁（中位数=40 岁）。
3 例诊断为结核性胸膜炎或非特异性胸膜炎的患者采用引流和抗生素或抗结核治疗。3 例患者成功进行了胸腔剥脱术。其他患者采用了开放性引流。最终诊断为 5 例结核性脓胸、3 例慢性纤维蛋白性胸膜炎和 1 例鳞状细胞癌。除了 2 例患者（1 例为多系统衰竭，1 例为鳞状细胞癌），所有患者均无并发症出院。
在某些患者中，手术在化脓性胸膜炎的治疗中起着关键作用。在不同的情况下，可选择管引流、开放引流和胸腔剥脱术来消灭脓腔并恢复肺功能。
