Vishnu Rajkamal, Rai Guruprasad D, Kamath Ganesh Sevagur, Kumara Vijaya
Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Department of Anesthesia, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
J Chest Surg. 2021 Apr 5;54(2):137-142. doi: 10.5090/jcs.20.144.
Refractory empyemas with collapsed lung and persistent bronchopleural fistulas pose significant problems to thoracic surgeons and impose a substantial burden in terms of morbidity and mortality. The modified Eloesser flap procedure is a useful palliative option for clearing infections. Herein, we present our experiences with the modified Eloesser flap procedure in mixed suppurative lung pathologies with a new technique of irrigation for persistent infection.
A retrospective review was carried out of 56 patients who underwent the modified Eloesser flap with continuous irrigation at Katurba Medical College. These patients had severe morbidities and were not suitable for major thoracic resection surgery, and electively underwent modified Eloesser flap surgery. Regular follow-up was done at 1, 3, 6, and 12 months. Patients with persistent infections were treated with our continuous irrigation technique.
The most important finding was that all patients with active sputum acid-fast bacilli-positive findings became sputum smear-negative during the first month of follow- up. Half (50%) of the patients had a patent stoma. Eleven patients had persistent infections, necessitating continuous irrigation. The infection was fully cleared after 1 month in 9 patients, while 2 patients required second irrigation and continued to receive follow-up. In the remaining 50% of the patients, the stoma closed completely, and the lung expanded fully.
The modified Eloesser flap is a simple procedure. In suppurative pathologies, infections were well controlled and the general condition of the patients improved. Our continuous irrigation method showed promising results in patients with persistent purulent discharge.
伴有肺萎陷和持续性支气管胸膜瘘的难治性脓胸给胸外科医生带来了重大问题，并在发病率和死亡率方面造成了沉重负担。改良的埃勒塞尔皮瓣手术是清除感染的一种有用的姑息性选择。在此，我们介绍我们在混合性化脓性肺部疾病中采用改良埃勒塞尔皮瓣手术并结合一种新的持续性感染冲洗技术的经验。
对在卡图尔巴医学院接受改良埃勒塞尔皮瓣并持续冲洗的56例患者进行回顾性研究。这些患者病情严重，不适合进行大型胸外科切除术，因此选择性地接受了改良埃勒塞尔皮瓣手术。在1、3、6和12个月进行定期随访。对持续性感染的患者采用我们的持续冲洗技术进行治疗。
最重要的发现是，所有痰涂片抗酸杆菌阳性的活跃患者在随访的第一个月内痰涂片均转为阴性。一半（50%）的患者造口通畅。11例患者存在持续性感染，需要持续冲洗。9例患者在1个月后感染完全清除，而2例患者需要第二次冲洗并继续接受随访。在其余50%的患者中，造口完全闭合，肺完全复张。
改良的埃勒塞尔皮瓣手术是一种简单的手术。在化脓性疾病中，可以很好地控制感染，患者的一般状况得到改善。我们的持续冲洗方法在有持续性脓性分泌物的患者中显示出了有前景的结果。
