Muskett A, Burton N A, Karwande S V, Collins M P
Division of Cardiothoracic Surgery, University of Utah Medical School, Salt Lake City 84132.
Am J Surg. 1988 Dec;156(6):529-32. doi: 10.1016/s0002-9610(88)80546-4.
One hundred consecutive patients underwent surgical procedures for empyema. Sixty-six patient acquired empyema from pneumonia, 16 from trauma, 11 from abdominal sepsis, and 7 from other causes. If tube thoracostomy failed, computerized tomography and ultrasonography were used to demonstrate a loculated empyema. After a median observation period of 11 days, 91 patients underwent thoracotomy and decortication and 9 patients underwent either rib resection, an Eloesser flap procedure, or both. The mortality rate was 6 percent 30 days postoperatively, the in-hospital mortality rate was 9 percent, and the overall morbidity rate was 17 percent. An excellent result was achieved in 85 percent of the patients with a recurrence rate of 4 percent. Gram-positive aerobes were the most common organisms cultured, but several opportunistic infections were encountered. We have concluded that early thoracotomy and decortication of empyema results in eradication of difficult pleural infections with hospital stays of an acceptable length and reasonably low morbidity and mortality rates.
连续100例患者接受了脓胸手术。66例患者的脓胸由肺炎引起，16例由创伤引起，11例由腹部脓毒症引起，7例由其他原因引起。如果胸腔闭式引流失败，采用计算机断层扫描和超声检查来显示局限性脓胸。在中位观察期11天后，91例患者接受了开胸剥脱术，9例患者接受了肋骨切除术、埃勒塞尔皮瓣手术或两者都接受了。术后30天死亡率为6%，住院死亡率为9%，总体发病率为17%。85%的患者取得了优异的结果，复发率为4%。革兰氏阳性需氧菌是培养出的最常见病原体，但也遇到了几种机会性感染。我们得出结论，早期开胸剥脱术治疗脓胸可根除难治性胸膜感染，住院时间可接受，发病率和死亡率较低。
