外科胸膜剥脱术作为脓胸的一线治疗方法。

Surgical decortication as the first-line treatment for pleural empyema.

机构信息

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.

Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.

出版信息

J Thorac Cardiovasc Surg. 2013 Apr;145(4):933-939.e1. doi: 10.1016/j.jtcvs.2012.07.035. Epub 2012 Aug 25.

DOI:10.1016/j.jtcvs.2012.07.035

PMID:22929218

Abstract

OBJECTIVE

The study objective was to evaluate the clinical outcomes of surgical decortication as the first line of treatment for pleural empyema.

METHODS

We analyzed the medical records of 111 patients who presented with empyema and were treated with simple drainage or surgical decortication as the first line of treatment at Gangnam Severance Hospital, a tertiary referral medical center in Seoul, Korea.

RESULTS

Of 111 patients with empyema, 27 underwent surgical decortication as the first intervention. Surgical decortication showed a better treatment success rate in all study subjects (96.3%, 26/27 patients) compared with simple drainage (58.3%, 49/84 patients; P < .0001 for method comparison). After propensity-scored matching, decortication resulted in a better outcome (95.0%, 19/20 patients) versus drainage (56.7%, 17/30 patients; P = .003). Surgical decortication as the first line of treatment for empyema was the best predictor of treatment success after adjustment for compounding factors (odds ratio, 14.529; 95% confidence interval, 1.715-123.074; P = .014).

CONCLUSIONS

The first treatment choice for pleural empyema is a critical determinant of ultimate therapeutic success. After adjusting for confounding variables, surgical decortication is the optimal first treatment choice for advanced empyema.

摘要

目的

本研究旨在评估外科清创术作为治疗脓胸的一线治疗方法的临床疗效。

方法

我们分析了在韩国首尔的江南塞弗伦斯医院就诊的 111 例脓胸患者的病历，这些患者均接受单纯引流或外科清创术作为一线治疗。

结果

在 111 例脓胸中，27 例患者接受了外科清创术作为一线干预措施。与单纯引流（58.3%，49/84 例）相比，外科清创术在所有研究对象中的治疗成功率更高（96.3%，26/27 例；P<.0001 用于方法比较）。经过倾向评分匹配后，清创术的结果优于引流术（95.0%，19/20 例比 56.7%，17/30 例；P=0.003）。对于复杂因素进行调整后，外科清创术作为脓胸的一线治疗是治疗成功的最佳预测因素（优势比，14.529；95%置信区间，1.715-123.074；P=0.014）。