Porcel José M
Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain.
Clin Respir J. 2018 Apr;12(4):1361-1366. doi: 10.1111/crj.12730. Epub 2017 Nov 23.
To summarize the evidence underlying the non-surgical management of patients with complicated parapneumonic effusions (CPPE) or empyemas.
All articles published in PubMed according to their relevance with the subject were identified.
There is a lack of powered randomized controlled studies comparing medical and surgical approaches to CPPE/empyemas in adults. In addition to antibiotics for an unspecified period of time, CPPE/empyemas can initially be treated with a therapeutic thoracentesis (which can be repeated if necessary), the insertion of a small-bore chest catheter under ultrasound guidance, or the administration through the catheter of fibrinolytics alone, saline alone or fibrinolytics in combination with either saline or deoxyribonuclease. These conservative measures resolve more than 90% of the cases, thus making a rescue surgery unnecessary.
总结复杂性类肺炎性胸腔积液（CPPE）或脓胸患者非手术治疗的相关证据。
根据与该主题的相关性，检索了PubMed上发表的所有文章。
目前缺乏针对成人CPPE/脓胸的内科与外科治疗方法对比的有力随机对照研究。除了在未明确的时间段内使用抗生素外，CPPE/脓胸最初可采用治疗性胸腔穿刺术（必要时可重复）、在超声引导下插入细胸导管，或通过导管单独给予纤维蛋白溶解剂、单独给予生理盐水，或纤维蛋白溶解剂与生理盐水或脱氧核糖核酸酶联合使用。这些保守措施可使超过90%的病例得到解决，从而无需进行挽救性手术。
