Hecker E, Hamouri S, Müller E, Ewig S
Thoraxzentrum Ruhrgebiet, Klinik für Thoraxchirurgie, Herne, Deutschland.
Zentralbl Chir. 2012 Jun;137(3):248-56. doi: 10.1055/s-0031-1284047. Epub 2012 Jun 18.
Parapneumonic pleural empyema has been classified into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, Light has classified pleural empyema according to the radiological, physical and biochemical characteristics, and the American College of Chest Physician (ACCP) has categorised the patients with pleural empyema according to the risk of a poor outcome. According to this classification the management of the pleural empyema is based on the stage of the disease. Therapeutic strategies include chest tube, chest tube with fibrinolysis, thoracoscopic debridement and decortication in open or minimally invasive techniques. Primary lung abscesses develop in previously healthy lung parenchyma and are caused by aspiration. In addition, abscess formation can occur without aspiration, and important differences relate to community-acquired, nosocomial abscesses and those in the immunosuppressed host. 90 % of all lung abscesses can be cured with antibiotic treatment alone, 10 % have to be treated with an interventional catheter or chest tubes and only 1 % require thoracic surgery because of complications independent of the former conservative or interventional treatment strategies.
肺炎旁胸腔积脓已被分为不同阶段和类别。美国胸科学会（ATS）的分类基于疾病的自然病程，而莱特根据放射学、体格检查和生化特征对胸腔积脓进行了分类，美国胸科医师学会（ACCP）则根据预后不良的风险对胸腔积脓患者进行了分类。根据这种分类，胸腔积脓的治疗基于疾病的阶段。治疗策略包括胸腔闭式引流、胸腔闭式引流联合纤维蛋白溶解治疗、胸腔镜清创术以及开放或微创技术下的胸膜剥脱术。原发性肺脓肿发生在先前健康的肺实质中，由误吸引起。此外，在没有误吸的情况下也可发生脓肿形成，社区获得性、医院获得性脓肿以及免疫抑制宿主中的脓肿存在重要差异。所有肺脓肿中90%仅通过抗生素治疗即可治愈，10%必须采用介入导管或胸腔闭式引流治疗，只有1%因与先前的保守或介入治疗策略无关的并发症而需要进行胸外科手术。
