Department of Paediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
Curr Med Res Opin. 2012 Jul;28(7):1179-92. doi: 10.1185/03007995.2012.684674. Epub 2012 May 22.
Parapneumonic effusions (PPE) and empyema, secondary to bacterial pneumonia, are relatively uncommon but their prevalence is increasing lately. Even if their prognosis is generally good, they may still cause significant morbidity. The traditional treatment of PPE has been intravenous antibiotics and, when necessary, chest tube drainage. Open thoracotomy with decortication has usually been applied in case of failure of the traditional approach. Lately, the use of fibrinolysis and/or video-assisted thoracoscopic surgery (VATS) are utilized in the management of PPE; however, there is still little consensus on the most effective primary treatment.
In this article our goal was to summarize, based on up-to-date evidence, all the management options for PPE available to physicians and weigh the benefits and risks of the most popular ones, in an effort to figure out which one is superior as a first-line approach in children.
A literature search of randomized and retrospective studies that pinpoint methods of evaluation and treatment of PPE was carried out in Medline and Scopus databases. Chest X-ray, ultrasound as well as microbiology and biochemical characteristics of the pleural fluid will facilitate decision-making. Small uncomplicated effusions resolve with antibiotics alone, larger ones require small-bore chest tube drainage and in case of complicated loculated PPE, fibrinolysis or VATS should be considered. Both methods promote faster drainage, reduce hospital stay and obviate the need for further interventions when used as first-line approach. However, primary treatment with VATS is not advised by the majority of studies as a first choice intervention, unless medical treatment has failed.
The main steps in treatment are diagnostic thoracocentesis and imaging, small percutaneous drainage, and considering fibrinolysis in complicated PPE. In case of failure, VATS should be the surgical method to be applied.
细菌性肺炎继发的脓胸和胸腔渗出液（PPE）虽然不常见，但最近其发病率有所增加。即使它们的预后通常良好，但仍可能导致显著的发病率。传统的 PPE 治疗方法是静脉内抗生素治疗，必要时进行胸腔引流管引流。如果传统方法失败，通常会采用开胸胸廓剥脱术。最近，纤维蛋白溶解和/或电视辅助胸腔镜手术（VATS）也用于 PPE 的治疗，但对于最有效的一线治疗方法仍缺乏共识。
本文旨在根据最新证据总结医生可用于治疗 PPE 的所有管理选择，并权衡最常用的治疗方法的利弊，以确定哪种方法作为儿童的一线治疗方法更具优势。
在 Medline 和 Scopus 数据库中进行了针对 PPE 评估和治疗方法的随机和回顾性研究的文献检索。胸部 X 线、超声以及胸腔液的微生物学和生化特征将有助于决策。小而不复杂的胸腔渗出液仅用抗生素即可解决，较大的胸腔渗出液需要小口径胸腔引流管引流，而对于复杂的胸腔渗出液，应考虑纤维蛋白溶解或 VATS。这两种方法都能促进更快的引流，缩短住院时间，并在作为一线治疗方法时避免进一步干预的需要。然而，大多数研究不建议将 VATS 作为一线治疗方法作为首选干预措施，除非药物治疗失败。
治疗的主要步骤是诊断性胸腔穿刺和影像学检查、小口径经皮引流，以及在复杂的 PPE 中考虑纤维蛋白溶解。如果治疗失败，VATS 应作为应用的手术方法。
