Foglia R P, Randolph J
J Pediatr Surg. 1987 Jan;22(1):28-33. doi: 10.1016/s0022-3468(87)80009-x.
Although most children with empyema respond to antibiotics and pleural drainage, a recognizable number fail to improve. This study reviews experience with ten children over the past 7 years who have been selected for lung decortication for refractory empyema. Decortication was performed because of lack of clinical improvement despite drainage and multiple antibiotics during an average 20-day preoperative hospitalization. Responsible organisms included beta-hemolytic Streptococcus, Streptococcus pneumoniae, and Hemophilus influenzae. A computerized tomographic (CT) scan of the chest was performed in the last eight patients and showed at least a 50% limitation of lung expansion by the products of the empyema in each case. Following decortication, chest tubes were removed, antibiotics stopped, and temperature and white blood cell count returned promptly to normal. The advantages of early decortication in selected patients with empyema who do not respond to antibiotics and drainage include low morbidity, shorter hospitalization, and excellent long-term results.
尽管大多数脓胸患儿对抗生素治疗和胸腔引流有反应，但仍有相当一部分患儿病情未见改善。本研究回顾了过去7年中因难治性脓胸而接受肺剥脱术的10名患儿的治疗经验。进行剥脱术的原因是，尽管在术前平均20天的住院期间进行了引流和多种抗生素治疗，但临床症状仍无改善。致病微生物包括β溶血性链球菌、肺炎链球菌和流感嗜血杆菌。对最后8例患者进行了胸部计算机断层扫描（CT），结果显示，每例患者脓胸产物导致的肺扩张受限至少达50%。剥脱术后，胸腔引流管拔除，停用抗生素，体温和白细胞计数迅速恢复正常。对于对抗生素治疗和引流无反应的脓胸患儿，早期进行剥脱术具有发病率低、住院时间短和长期效果良好等优点。
