Lakranbi M, Rabiou S, Belliraj L, Issoufou I, Ammor F Z, Ghalimi J, Ouadnouni Y, Smahi M
Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc.
Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc.
Rev Pneumol Clin. 2016 Dec;72(6):333-339. doi: 10.1016/j.pneumo.2016.08.004. Epub 2016 Oct 21.
The occurrence of empyema after pneumonectomy or in suites with chronic pleural pocket is a dreaded complication. The management is long and difficult. The authors report their experience before this complication including infection control by an emptying of the pleural pocket percutaneous drainage or thoracostomy which will be complemented by a thoracomyoplasty the aim to erase the pleural pocket.
This is a retrospective study conducted between 2009 and 2015 concerning the records of 9 patients treated for empyema or in the aftermath of a lung resection or as part of a chronic pleural pocket and calcific.
We had identified all 9 male patients aged 30 to 67 years. This was pyothorax complicating pneumonectomy in 4 patients and 1 pyothorax after a left upper lobectomy in 1 case. For the other 4 patients, there was a post-tuberculous pleural pocket, calcified chronic and whose attempts to decortication seemed impossible. We observed 3 cases of bronchopleural fistula. All patients had received evacuation of the contents of the pleural drainage bag is either thoracostomy laying the bed of a possible filling thoracomyoplasty. The evolution of pleural cavities after thoracostomy was favorable on septic map leading to a retraction of the pleural cavity and its spontaneous closure in 1 patient. In 6 patients, filling the cavity with thoracomyoplasty was necessary. The evolution immediate postoperative was favorable in all patients and no deaths were noted in connection with this technique.
Pyothorax on pneumonectomy cavity and chronic pleural calcified pockets are serious complications whose management is long and delicate. The thoracomyoplastie is a real alternative to the filling of the cavity in fragile patients with significant operational risk. The results are satisfactory in the hands of a broken team this technique.
肺切除术后或伴有慢性胸膜腔的患者发生脓胸是一种可怕的并发症。其治疗过程漫长且困难。作者报告了他们在处理这一并发症之前的经验，包括通过经皮引流或胸廓造口术排空胸膜腔来控制感染，并辅以胸廓成形术以消除胸膜腔。
这是一项回顾性研究，对2009年至2015年间9例因脓胸接受治疗、肺切除术后或作为慢性胸膜腔及钙化病变一部分接受治疗的患者记录进行分析。
我们确定了所有9例男性患者，年龄在30至67岁之间。其中4例为肺切除术后并发脓胸，1例为左上肺叶切除术后并发脓胸。另外4例患者存在结核后胸膜腔，慢性且钙化，似乎无法进行胸膜剥脱术。我们观察到3例支气管胸膜瘘。所有患者均接受了胸膜腔引流袋内容物的排空，要么是胸廓造口术，为可能的胸廓成形术填充创造条件。胸廓造口术后胸膜腔的演变在感染指标方面是有利的，导致1例患者胸膜腔回缩并自发闭合。6例患者需要进行胸廓成形术填充胸腔。所有患者术后早期演变良好，未因该技术出现死亡病例。
肺切除术后胸腔脓胸和慢性胸膜钙化腔是严重并发症，其治疗过程漫长且棘手。胸廓成形术对于手术风险高的脆弱患者来说是填充胸腔的一种切实可行的替代方法。在熟练掌握该技术的团队手中，结果令人满意。
