Sakai Takashi, Sano Atsushi, Shimizu Hiroshige, Azuma Yoko, Urabe Naohisa, Isobe Kazutoshi, Sakamoto Susumu, Takai Yujiro, Murakami Yoshitaka, Kishi Kazuma, Iyoda Akira
Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
Division of Respiratory Medicine, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan.
J Thorac Dis. 2022 Jun;14(6):1990-1999. doi: 10.21037/jtd-21-1812.
The indication for and the timing of surgery in patients with pleural infection remains unclear. Determining the need for surgery in patients with pleural infection may help in the early consultation of surgeons.
Data of 167 consecutive patients with pleural infection were retrospectively reviewed. To detect a surgical indicator, the variables of patients who required surgery were compared with those of patients who were cured by non-surgical therapy (n=94) and patients resistant to the non-surgical therapy (n=73; 62 underwent surgery, and 11 showed recurrence or disease-related death after non-surgical treatment). Prognosis and timing of surgery were analyzed by comparing three groups: patients who underwent surgery within 7 days of admission (n=33), patients who underwent surgery after 7 days of admission (n=29), and patients who underwent non-surgical therapy (n=105).
The presence of multifocal locules, including a locule on the anterior mediastinum side (LAMS) was a significant indicator of resistance to initial non-surgical therapy, as compared to the absence of locules (P<0.0001), a single locule (P<0.0001), or multifocal locules without a LAMS (P=0.0041). Recurrence and mortality were not observed in the patients who underwent surgery within 7 days of admission, and the hospitalization period (P=0.0071) and duration of C-reactive protein (CRP) improvement (P<0.0001) were significantly shorter in these patients compared with those who that underwent surgery after 7 days.
In patients with pleural infection, the presence of multifocal locules, including a LAMS, was associated with resistance to non-surgical therapy. Early surgery should be considered for these patients to shorten the hospitalization period and improve the prognosis.
胸膜感染患者的手术指征和时机仍不明确。确定胸膜感染患者的手术需求可能有助于早期咨询外科医生。
回顾性分析167例连续性胸膜感染患者的数据。为了检测手术指标，将需要手术的患者变量与通过非手术治疗治愈的患者（n = 94）以及对非手术治疗耐药的患者（n = 73；62例接受手术，11例在非手术治疗后出现复发或与疾病相关的死亡）进行比较。通过比较三组患者分析手术的预后和时机：入院7天内接受手术的患者（n = 33）、入院7天后接受手术的患者（n = 29）和接受非手术治疗的患者（n = 105）。
与无分隔（P < 0.0001）、单个分隔（P < 0.0001）或无前纵隔侧分隔（LAMS）的多灶性分隔（P = 0.0041）相比，存在多灶性分隔，包括前纵隔侧分隔（LAMS）是对初始非手术治疗耐药的显著指标。入院7天内接受手术的患者未观察到复发和死亡，与入院7天后接受手术的患者相比，这些患者的住院时间（P = 0.0071）和C反应蛋白（CRP）改善持续时间（P < 0.0001）明显更短。
在胸膜感染患者中，存在多灶性分隔，包括LAMS，与对非手术治疗的耐药性相关。对于这些患者应考虑早期手术以缩短住院时间并改善预后。
