Fukui Tetsuya, Matsukura Tadashi, Wakatsuki Yusuke, Yamawaki Satoko
Department of General Thoracic Surgery, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi Fukui, Fukui, 918-8501, Japan.
Department of Plastic Surgery, Japanese Red Cross Fukui Hospital, Fukui, 2-4-1 Tsukimi Fukui, 918-8501, Japan.
Surg Case Rep. 2019 Apr 5;5(1):53. doi: 10.1186/s40792-019-0612-y.
Management of postpneumonectomy empyema requires comprehensive strategies, especially when the condition is associated with large bronchopleural fistulae. We report a case involving the simple chest closure of open window thoracostomy with remaining residual space.
We performed open window thoracostomy for empyema with a huge bronchial stump dehiscence after right pneumonectomy for a large lung cancer. We definitively closed the chest window infected with chronic persistent Pseudomonas aeruginosa via a simple chest closure technique with the remaining residual space, after repairing the bronchial dehiscence using an omental flap and the appearance of healthy granulation tissue throughout the cavity. The patient died of recurrent cancer 10 months after the definitive chest closure. Until the patient died, there were no symptoms or signs suggestive of recurrent empyema.
This simple chest closure technique allows "silent empyema" to be observed carefully, is less invasive, and can even be applied to cases of recurrent cancer.
肺切除术后脓胸的管理需要综合策略，尤其是当病情与大的支气管胸膜瘘相关时。我们报告一例涉及开放性胸廓造口术简单胸廓闭合且留有残余空间的病例。
我们对一名因巨大肺癌行右肺切除术后发生脓胸且伴有巨大支气管残端裂开的患者实施了开放性胸廓造口术。在使用网膜瓣修复支气管裂开且整个腔隙出现健康肉芽组织后，我们通过一种留有残余空间的简单胸廓闭合技术明确闭合了感染慢性持续性铜绿假单胞菌的胸廓窗口。患者在胸廓明确闭合10个月后死于复发性癌症。直至患者死亡，均无提示复发性脓胸的症状或体征。
这种简单的胸廓闭合技术能够仔细观察“隐匿性脓胸”，侵入性较小，甚至可应用于复发性癌症病例。
