Marienkrankenhaus: Katholisches Marienkrankenhaus GmbH, Hamburg, Germany.
Chirurgie (Heidelb). 2023 Jun;94(6):530-543. doi: 10.1007/s00104-023-01827-8. Epub 2023 Mar 15.
We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on a case series.
ITNPT represents a further development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements 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.
In total, 31 patients with stage II and III pleural empyema underwent ITNPT, which was administered during the primary procedure (n = 17) or at revision (n = 14). Treatment duration was a mean of 10 days (2-18 days) with a mean change interval of 4 days (2-6 days). Intrathoracic negative pressure dressings were applied a mean of 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 surgical dressings must 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.
我们报告了根据病例系列，在胸腔调整治疗的基础上，使用胸腔内负压治疗（ITNPT）治疗脓胸（PE）的初步经验。
ITNPT 是胸腔内应用的进一步发展。在胸外科开放性清创术后，插入胸腔内负压敷料。引流元素是带有开孔聚氨酯泡沫（PUF）的薄开孔双层引流膜（OF）。只有 OF 与肺实质直接接触。使用电子泵（持续抽吸，-75mmHg）产生负压。在再次开胸手术中，根据局部发现决定是否停止或继续使用 ITNPT。
共有 31 例 II 期和 III 期脓胸患者接受了 ITNPT，其中 17 例在初次手术中进行，14 例在再次开胸手术中进行。治疗持续时间平均为 10 天（2-18 天），平均更换间隔为 4 天（2-6 天）。胸腔内负压敷料的使用次数平均为 3.5 次（1-6 次）。脓腔连续缩小并通过抽吸清洁。OF 具有最小的固有体积和最大的吸收面积。一旦建立负压，就没有胸腔内死腔，肺组织可以扩张。OF 的保护材料特性使其适合脓胸的治疗。针对感染焦点的靶向局部胸腔内引流可能是手术的辅助手段。外科敷料必须反复更换。该方法适用于治疗复杂的 II 期和 III 期脓胸。
OF 可作为脓胸 ITNPT 的胸腔内引流元素。这种新的应用选择扩展了负压治疗的适应证范围。
