Ahn Hyo Yeong, Cho Jeong Su, Kim Yeong Dae, Hoseok I
Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Thorac Cardiovasc Surg. 2013 Mar;61(2):167-71. doi: 10.1055/s-0032-1311552. Epub 2012 Jun 22.
The effective management of chronic tuberculous empyema requires an evacuation of pus and a re-expansion of the lung or an obliteration of the empyema space such as closed thoracostomy, decortication, or open window thoracostomy (OWT) followed by intrathoracic muscular transposition (IMT). However, the most effective management of chronic tuberculous empyema is still debatable.
From June 1999 to July 2010, 18 patients with chronic tuberculous empyema who underwent OWT and/or IMT were enrolled in this study. The causes of empyema, and methods and outcomes of treatment were retrospectively reviewed. The success rate of IMT was investigated to evaluate the efficacy.
Mean patient age was 54.3 ± 14.9 years and 16 patients were male. Depending on operative methods, three groups were divided: OWT only (n = 4); two-stage operation as OWT followed by IMT (n = 7); and one-stage operation as OWT with IMT simultaneously (n = 7). Of 14 patients who underwent IMT, 13 patients successfully recovered from empyema and bronchopleural fistula (BPF) (success rate, 92.86%), but one patient developed a secondary bacterial infection. There was no operative mortality.
This study suggests that IMT may be an effective option to control infection or BPF in chronic tuberculous empyema.
慢性结核性脓胸的有效管理需要排出脓液并使肺复张或闭塞脓腔，如闭式胸腔引流术、胸膜纤维板剥脱术或开窗胸廓造口术（OWT），随后进行胸内肌肉移位术（IMT）。然而，慢性结核性脓胸的最有效管理方法仍存在争议。
从1999年6月至2010年7月，18例接受OWT和/或IMT的慢性结核性脓胸患者纳入本研究。回顾性分析脓胸的病因、治疗方法及结果。研究IMT的成功率以评估疗效。
患者平均年龄为54.3±14.9岁，男性16例。根据手术方法分为三组：单纯OWT组（n = 4）；OWT后行IMT的两阶段手术组（n = 7）；OWT同时行IMT的一阶段手术组（n = 7）。在14例行IMT的患者中，13例脓胸和支气管胸膜瘘（BPF）成功治愈（成功率92.86%），但1例发生继发性细菌感染。无手术死亡病例。
本研究提示IMT可能是控制慢性结核性脓胸感染或BPF的有效选择。
