Botianu Petre Vlah-Horea, Botianu Alexandru-Mihail
Surgical Clinic 4, University of Medicine and Pharmacy, Tirgu-Mures, Romania.
Thorac Cardiovasc Surg. 2013 Oct;61(7):626-30. doi: 10.1055/s-0033-1354589. Epub 2013 Aug 29.
The objective of this study is to perform a retrospective analysis of our experience in using muscle flaps and thoracomyoplasty for unresectable primary pulmonary abscesses.
Between January 1, 2003, and January 1, 2012, we have used different muscle flaps and thoracomyoplasty in 15 patients with unresectable primary pulmonary abscesses. Muscle transposition was used alone (3 cases) or during thoracomyoplasty procedures for lung abscesses complicated with empyema (12 cases). The objective of the procedure was complete obliteration of the diseased space, with additional limited thoracoplasty being required in 12 out of 15 patients (average resected ribs: 3.7); bronchial fistula were encountered in 9 patients and were closed-reinforced using muscle flaps. The following parameters were followed: mortality, morbidity, intensive care and overall postoperative hospitalization, recurrence, and late sequelae.
We have encountered one postoperative death (6.7%) and an overall 46.7% morbidity. Intensive-care unit stay ranged between 1 and 5 days with a median of 2. Overall postoperative hospitalization ranged between 22 and 46 days, with a median of 32 days. At late 1-year follow-up, we encountered no recurrence and no major chest deformity with a moderate limitation of shoulder mobility in two patients.
Space-filling procedures are a valuable solution for unresectable primary pulmonary abscesses, allowing the avoidance of open drainage and pleuropneumonectomy. The extensive mobilization of the flaps offers a good-quality biological material with considerable volume.
本研究的目的是对我们使用肌皮瓣和胸廓成形术治疗无法切除的原发性肺脓肿的经验进行回顾性分析。
在2003年1月1日至2012年1月1日期间，我们对15例无法切除的原发性肺脓肿患者使用了不同的肌皮瓣和胸廓成形术。单独使用肌肉移位术（3例）或在胸廓成形术过程中用于治疗合并脓胸的肺脓肿（12例）。手术的目的是完全消除病变空间，15例患者中有12例需要额外进行有限的胸廓成形术（平均切除肋骨：3.7根）；9例患者出现支气管瘘，使用肌皮瓣进行封闭加固。对以下参数进行了跟踪：死亡率、发病率、重症监护和术后总体住院时间、复发情况以及晚期后遗症。
我们遇到1例术后死亡（6.7%），总体发病率为46.7%。重症监护病房停留时间为1至5天，中位数为2天。术后总体住院时间为22至46天，中位数为32天。在1年的后期随访中，我们未发现复发，也没有严重的胸部畸形，2例患者肩部活动有中度受限。
填充手术是治疗无法切除的原发性肺脓肿的一种有价值的解决方案，可避免开放引流和胸膜肺切除术。皮瓣的广泛移动提供了一种高质量且体积可观的生物材料。
