Muranishi Yuusuke, Yasuo Ueshima
Department of Respiratory Surgery, Japanese Red Cross Kyoto Daiichi Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Dec;49(12):917-21.
A 78-year-old man was referred to our hospital because of pyrexia in October 2008. Chest X-ray films and chest computed tomography (CT) indicated chronic tuberculous empyema in the right hemithorax. His general condition was not improved by antibiotic treatment, and CT showed pyothorax with a niveau and bronchial fistulas in May 2009. We subsequently performed open window thoracostomy and decortication of the residual dead spaces, but the bronchial fistulas remained. As this approach makes it difficult to ensure the sterility of the cavity, we therefore performed fiberoptic bronchoscopy and occluded the bronchus with an endobronchial Watanabe spigot (EWS). However, the bronchial fistula recurred, and therefore we performed this treatment again. We continued to carefully wash the cavity and the leakage stopped, whereupon the cavity became sterile. We then performed omental pedicle and muscle flap closure and thoracoplasty in April 2010. The empyema was cured without any complications. These findings suggest that using an EWS before surgery can be highly effective in controlling chronic tuberculous empyema with fistulas.
一名78岁男性因发热于2008年10月被转诊至我院。胸部X线片和胸部计算机断层扫描（CT）显示右半胸慢性结核性脓胸。抗生素治疗后其一般状况未改善，2009年5月CT显示脓胸伴液平及支气管瘘。我们随后进行了开窗胸廓造口术及残余死腔的剥脱术，但支气管瘘仍存在。由于这种方法难以确保腔隙的无菌状态，因此我们进行了纤维支气管镜检查，并用支气管内渡边栓子（EWS）封堵支气管。然而，支气管瘘复发，因此我们再次进行了该治疗。我们持续仔细冲洗腔隙，漏液停止，随后腔隙变为无菌状态。然后我们于2010年4月进行了网膜蒂和肌瓣闭合术及胸廓成形术。脓胸治愈，无任何并发症。这些结果表明，术前使用EWS对控制伴有瘘的慢性结核性脓胸可能非常有效。
