Barglik Roksana, Grabowski Andrzej, Korlacki Wojciech, Pasierbek Michał, Modrzyk Anna
Department of Children Developmental Defects Surgery and Traumatology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):264-272. doi: 10.5114/wiitm.2020.97443. Epub 2020 Nov 26.
Pleural empyema is the condition of the pleural cavity when initially sterile pleural effusion has become infected. In the majority of cases, it is of parapneumonic origin. Parapneumonic effusions and pleural empyemata usually continuously progress in severity. The American Thoracic Society divides them into three stages: exudative, fibrinopurulent and organizing. The therapy depends on the stage.
To assess whether thoracoscopy should be considered better than conservative treatment and to assess the feasibility of the thoracoscopic approach to the 3 phase of pleural empyema.
The clinical course of 115 patients treated from 1996 to 2017 was analyzed. 45 patients operated on thoracoscopically after the failure of conventional treatment were compared with 70 patients treated by primary thoracoscopic drainage and decortication.
The results of the study demonstrated that patients treated primarily by thoracoscopy had a shortened length of hospital stay (16.6 vs. 19.3 days), reduced drainage time (7.9 vs. 9.8 days), and shorter time of general therapy (31.8 vs. 38.0 days). They required fibrinolysis less frequently (12.8 vs. 26.7% of patients) and had reduced risk of reoperation (10 vs. 15.6% of cases). Operation time in the 3 stage was only 15 min longer. The difference in length of hospital stay was only 0.8 days in favor of less severe cases.
The thoracoscopic approach is safely feasible in the 3 stage of pleural empyema and should be considered as the preferred approach. Furthermore, the post-operative stay and general course of the disease are milder whenever surgery would not be delayed by prolonged conservative treatment attempts.
胸膜腔积脓是指最初无菌的胸腔积液发生感染时的胸膜腔状况。在大多数情况下，它源于肺炎旁。肺炎旁胸腔积液和胸膜腔积脓通常会在严重程度上持续进展。美国胸科学会将它们分为三个阶段：渗出性、纤维脓性和机化性。治疗方法取决于阶段。
评估胸腔镜检查是否应被认为比保守治疗更好，并评估胸腔镜方法用于胸膜腔积脓第三阶段的可行性。
分析了1996年至2017年期间接受治疗的115例患者的临床病程。将45例在传统治疗失败后接受胸腔镜手术的患者与70例接受初次胸腔镜引流和剥脱术治疗的患者进行比较。
研究结果表明，主要接受胸腔镜检查治疗的患者住院时间缩短（16.6天对19.3天），引流时间减少（7.9天对9.8天），全身治疗时间缩短（31.8天对38.0天）。他们较少需要纤维蛋白溶解治疗（患者比例分别为12.8%对26.7%），再次手术风险降低（病例比例分别为10%对15.6%）。第三阶段的手术时间仅长15分钟。住院时间差异仅为0.8天，有利于病情较轻的病例。
胸腔镜方法在胸膜腔积脓第三阶段安全可行，应被视为首选方法。此外，只要手术不因长期保守治疗尝试而延迟，术后住院时间和疾病的总体病程会更轻。
