Kondov Goran, Spirovski Zoran, Kondova-Topuzovska Irena, Kokareva Anita, Colanceski Risto, Srceva M, Kondov Borislav, Dzikovski I, Toleska-Dimitrovska N, Petrusevska-Marinkovic Sanja
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Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2017 Sep 1;38(2):99-105. doi: 10.1515/prilozi-2017-0027.
Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema.
To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery.
In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty.
With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty - 3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty.
Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.
胸腔感染是一种常见的临床病症。已证实及时治疗可降低发病率、死亡率及住院时间。不幸的是，脓胸晚期需要进行广泛的手术——胸膜剥脱术或胸廓成形术。早期识别肺炎旁胸腔积液并通过胸腔穿刺术或胸腔引流进行充分治疗（这是微创的），有可能阻止病情进展且不会发展为脓胸。
分析在胸外科诊所接受治疗的脓胸患者的手术治疗结果。
在这项回顾性研究中，我们分析了234例在5年期间（2011 - 2015年）于胸外科诊所接受治疗的脓胸患者。患者的平均年龄为51.94岁。他们接受了胸腔引流、胸膜剥脱术或胸廓成形术治疗。
165/234（70.51%）例患者接受了胸腔引流，其中124/165（75.15%）例成功完成治疗，但41/165（24.85%）例在胸膜剥脱术后仍需进一步治疗。共有108/234（46.15%）例接受了胸膜剥脱术，其中67/234（28.63%）例患者进行了一期胸膜剥脱术。5/234（2.14%）例患者接受了胸廓成形术——根据局部情况、长期未治疗的脓胸及全身状况不佳，3例患者在胸膜剥脱术后进行了胸廓成形术，2例患者进行了一期胸廓成形术。平均住院时间为17.4天，其中术后住院13.4天。在一期引流组中，7/124（5.64%）例患者死亡，胸膜剥脱术组为5/105（4.76%）例，胸廓成形术组为2/5（40%）例。
早期发现肺炎旁胸腔积液并进行充分治疗可预防脓胸的出现。如果发现脓胸，有必要尽早开始采用微创胸腔引流进行治疗。在早期阶段，可以使用比开放性胸廓切开胸膜剥脱术创伤更小的电视辅助胸腔镜手术（VATS）进行胸膜剥脱术，开放性胸廓切开胸膜剥脱术是一种更广泛的外科手术干预。
