Department of Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi, 75400, Pakistan.
Department of Thoracic Surgery, Combined Military Hospital, Peshawar, Pakistan.
BMC Pulm Med. 2018 Nov 29;18(1):179. doi: 10.1186/s12890-018-0745-y.
The treatment of early pleural empyema depends on the treatment of ongoing infection by antimicrobial therapy along with thoracocentesis. In complicated empyema this treatment does not work and lung will not expand until removal of adhesions. The objective of the current study is to analyze the experience of management of multiloculated, exudative and fibrinopurulent empyema through rigid medical thoracoscopy under local anaesthesia and to explore new ways to manage the entity.
This is a descriptive case series in which 160 patients were recruited through non-probability convenient sampling, from department of pulmonology, Jinnah postgraduate medical centre, Karachi, from September 2014 to August 2016. All patients underwent medical thoracoscopy under local anesthesia. Written Informed consent was taken from the study participants. Ethical approval was obtained from Ethical Review Committee of the hospital. Patients age > 70 years, those with multiple organ failure and bleeding disorders were excluded.
Out of 160 patients, 108 (67.50%) were male and 52 (32.5%) were female with mean age 25.37 years (range 16 to 70 years). Out of total, 102 (63.7%) had tuberculous empyema, while pleural biopsy of 58 (36.3%) patients was suggestive of non-tuberculous empyema. Final evolution through chest x-ray revealed complete resolution in 92 (57.5%), partial resolution in 58 (36.25%) patients. 9 (5.6%) developed persistent air leak while 1 (0.6%) patient expired due to urosepsis.
Medical Thoracoscopy under local anesthesia is a safe, efficient and cost effective intervention for management of complicated empyema, particularly in resource constraint settings.
早期脓胸的治疗取决于通过抗菌治疗和胸腔穿刺来治疗持续的感染。在复杂的脓胸中，这种治疗方法不起作用，只有在去除粘连后肺部才会扩张。本研究的目的是分析局部麻醉下硬性内科胸腔镜治疗多房性、渗出性和纤维脓性脓胸的经验，并探索治疗该病的新方法。
这是一项描述性病例系列研究，2014 年 9 月至 2016 年 8 月期间，通过非概率方便抽样，从卡拉奇吉纳研究生医学中心呼吸科招募了 160 名患者。所有患者均在局部麻醉下接受内科胸腔镜检查。研究参与者签署了书面知情同意书。医院伦理审查委员会批准了该研究。排除年龄>70 岁、多器官功能衰竭和出血性疾病的患者。
在 160 名患者中，108 名（67.50%）为男性，52 名（32.5%）为女性，平均年龄 25.37 岁（16-70 岁）。在所有患者中，102 例（63.7%）为结核性脓胸，58 例（36.3%）患者的胸腔活检提示为非结核性脓胸。通过胸部 X 射线最终演变显示 92 例（57.5%）完全缓解，58 例（36.25%）部分缓解。9 例（5.6%）发生持续的气胸，1 例（0.6%）因尿路感染死亡。
局部麻醉下内科胸腔镜检查是一种安全、有效、经济有效的治疗复杂脓胸的方法，特别是在资源有限的情况下。
