Betz Viktoria, van Ackeren Vera, Scharsack Ernst, Stark Bettina, Müller Christian Theodor, Loske Gunnar
Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Katholisches Marienkrankenhaus gGmbH, Alfredstr. 9, 22087, Hamburg, Deutschland.
Chirurgie (Heidelb). 2023 Apr;94(4):349-360. doi: 10.1007/s00104-022-01800-x. Epub 2023 Feb 8.
We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted therapy of pleural empyema (PE) based on a case series.
ITNPT represents a further development in negative pressure therapy that is designed to be used in the thoracic cavity. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements used were a thin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, -75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings.
31 patients with stage II and III pleural empyemas were treated. ITNPT was administered at the time of primary procedure (n = 17) or revision (n = 14). ITNPT was given over a duration of m = 10 days (2-18 days), change interval m = 4 d (2-6 d). The application of intrathoracic negative pressure dressings was performed m = 3.5 (1-6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has a minimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand.
The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is a possible adjunct to surgery. The treatment regimen requires surgical dressings to be changed repeatedly. The method is suitable for the treatment of complex stage II and III pleural empyemas.
The OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.
我们基于一系列病例报告了胸腔负压疗法（ITNPT）在胸膜腔积脓（PE）分期调整治疗中的初步经验。
ITNPT是负压疗法的进一步发展，设计用于胸腔。在开胸手术清创后，插入胸腔负压敷料。使用的引流元件是带有开孔聚氨酯泡沫（PUF）的薄开孔双层引流膜（OF）。仅OF直接与肺实质接触。使用电子泵产生负压（持续吸引，-75 mmHg）。在再次开胸手术中，根据局部情况决定是否停止或继续ITNPT。
治疗了31例II期和III期胸膜腔积脓患者。ITNPT在初次手术时（n = 17）或再次手术时（n = 14）应用。ITNPT持续时间为m = 10天（2 - 18天），更换间隔m = 4天（2 - 6天）。胸腔负压敷料应用次数为m = 3.5次（1 - 6次）。脓腔大小持续缩小并通过吸引得以清洁。OF具有最小固有体积和最大吸收面积。一旦建立负压，胸腔内就没有死腔，肺实质可以扩张。
OF的保护材料特性使ITNPT适用于胸膜腔积脓的治疗。针对感染灶的靶向局部胸腔引流是手术的一种可能辅助手段。治疗方案需要反复更换手术敷料。该方法适用于治疗复杂的II期和III期胸膜腔积脓。
OF可作为ITNPT治疗胸膜腔积脓的胸腔引流元件。这种新的应用选择扩大了负压疗法的适应证范围。
