Department of Disease of the Thorax, Pulmonology Unit, Morgagni Hospital, Forlì, Italy.
Respiration. 2012;84(3):219-24. doi: 10.1159/000339414. Epub 2012 Jul 24.
Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment.
The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema.
We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011.
A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%).
Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate 'pockets' not in apparent communication with each other often leads to a surgical approach.
脓胸可分为 3 个阶段：渗出期、多房性和机化期。在没有明显分隔的情况下，抗生素联合单纯胸腔引流通常足以治疗，而明确的分隔通常需要更具侵袭性的治疗。
本研究旨在报告我们的经验，并分析在多房性和机化性脓胸中应用内科胸腔镜的安全性和疗效。
我们回顾性分析了 2005 年 7 月至 2011 年 2 月期间因脓胸在我科行内科胸腔镜治疗的患者的病历。
共 41 例脓胸患者接受内科胸腔镜治疗；9 例（22%）为自由流动的胸腔积液，24 例（58.5%）为多房性脓胸，8 例（19.5%）为机化性胸腔积液。41 例患者中有 35 例（85.4%）内科胸腔镜治疗无需进一步干预即获成功：9 例自由流动的胸腔积液患者均成功，24 例多房性脓胸患者中 22 例（91.7%）成功，8 例机化性胸腔积液患者中仅 4 例（50%）成功。
本研究证实，内科胸腔镜可安全、有效地治疗多房性脓胸，而机化性脓胸可能对内科胸腔镜引流有抵抗，需要行电视辅助胸腔镜手术或开胸廓清术；在这类患者中，存在明显分隔且彼此无明显交通的“分隔腔”往往需要手术治疗。
