Wehr C J, Adkins R B
South Med J. 1986 Feb;79(2):171-6. doi: 10.1097/00007611-198602000-00009.
Over a ten-year period, 50 patients with thoracic empyema have been treated at the Metropolitan Nashville General Hospital, where a systematic, stepwise approach to the management of empyema has been followed. The initial step was thoracentesis; if this failed to resolve the empyema, dependent thoracostomy tube drainage was used. Closed thoracostomy drainage was converted to open drainage when closed drainage failed to obliterate the empyema cavity. When all other measures failed, thoracotomy with pleural decortication was done. Of the 27 patients who had empyema as a consequence of pneumonia, most (14) were successfully treated with open empyema tube drainage, though five required decortication. Eight of the ten posttraumatic empyemas resolved with open drainage, but pleural decortication was necessary in the remaining two cases. Nine patients had postoperative empyemas; six were managed with open drainage, and three resolved with closed thoracostomy drainage. Of the four remaining empyemas, two resolved with closed drainage and two required open drainage. Treatment was successful in 85% of cases, with six deaths (15%). This experience with empyema shows that early, staged surgical management is successful in most cases. In our experience, the causative organism had no bearing on outcome. Resolution of the condition was possible only after adequate drainage and obliteration of the empyema space was accomplished.
在十年期间，纳什维尔都会区综合医院共治疗了50例胸腔积脓患者，该院采用了系统、逐步的胸腔积脓管理方法。第一步是胸腔穿刺术；如果这未能解决胸腔积脓问题，则采用胸腔闭式引流管引流。当闭式引流未能消除脓腔时，将闭式胸腔引流转换为开放引流。当所有其他措施均失败时，则进行开胸胸膜剥脱术。在因肺炎导致胸腔积脓的27例患者中，大多数（14例）通过开放脓胸引流管引流成功治愈，不过有5例需要进行胸膜剥脱术。10例创伤后脓胸中有8例通过开放引流治愈，但其余2例需要进行胸膜剥脱术。9例患者发生术后脓胸；6例采用开放引流治疗，3例通过闭式胸腔引流治愈。在其余4例脓胸中，2例通过闭式引流治愈，2例需要开放引流。85%的病例治疗成功，6例死亡（15%）。这种胸腔积脓的治疗经验表明，早期、分阶段的手术治疗在大多数情况下是成功的。根据我们的经验，致病微生物对治疗结果没有影响。只有在充分引流并消除脓腔后，病情才有可能得到缓解。
