Monsch Gian-Marco, Etienne Harry, Hillinger Sven, Caviezel Claudio, Lauk Olivia, Opitz Isabelle, Schneiter Didier
Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Sci Rep. 2024 Dec 30;14(1):31837. doi: 10.1038/s41598-024-83334-2.
Treatment of postpneumonectomy empyema remains challenging, especially in presence of bronchopleural fistula. We analysed clinical outcome data of patients with and without bronchopleural fistula undergoing an accelerated empyema treatment concept. From November 2005 to July 2020, all patients with postpneumonectomy empyema were included. Therapy consisted of repeated surgical debridement of the pleural cavity, evaluation for loco-regional flap, negative pressure wound therapy and definitive closure after installation an antibiotic solution in the cavity. Primary endpoint was perioperative mortality, focusing on comparison between patients with (= group A) and without bronchopleural fistula (= group B). Secondary endpoints were empyema resolution/recurrence and length of stay. 58 patients underwent the treatment concept: 19 (32.8%) with bronchopleural fistula. Patients' mean age was 62.7 ± 11.5 years. Nine patients (15.5%) deceased within 30 days: 3 (15.8%) in group A, 6 (15.4%) in group B. 90-days mortality tends to be lower in group A (n = 3 (15.8%)) compared to group B (n = 11 (28.2%)) (p = 0.078). Incidence of postoperative complication was 63.2% (n = 12) in group A compared to 56.4% (n = 22) in group B (p = 0.316). Postpneumonectomy empyema resolution was 100% in the cohort. 3 patients (15.8%) in the group A and 3 (7.7%) in group B (p = 0.175) developed an empyema-recurrence, successfully managed with the treatment concept again. Mean hospital length of stay was lower in group A (24.6 ± 9.5 days vs 27.2 ± 24.3 days in group B; p = 0.329). With our accelerated treatment concept, postpneumonectomy empyema with bronchopleural fistula could effectively and safely be treated while maintaining integrity of the chest wall. Clinical Registration Number: KEK-ZH-NR: 2021-01114.
肺切除术后脓胸的治疗仍然具有挑战性，尤其是在存在支气管胸膜瘘的情况下。我们分析了接受加速脓胸治疗方案的有和没有支气管胸膜瘘患者的临床结局数据。从2005年11月至2020年7月，纳入了所有肺切除术后脓胸患者。治疗包括反复手术清创胸膜腔、评估局部皮瓣、负压伤口治疗以及在胸腔内注入抗生素溶液后进行最终闭合。主要终点是围手术期死亡率，重点是比较有支气管胸膜瘘的患者（=A组）和没有支气管胸膜瘘的患者（=B组）。次要终点是脓胸消退/复发和住院时间。58例患者接受了该治疗方案：19例（32.8%）有支气管胸膜瘘。患者的平均年龄为62.7±11.5岁。9例患者（15.5%）在30天内死亡：A组3例（15.8%），B组6例（15.4%）。与B组（n = 11例（28.2%））相比，A组（n = 3例（15.8%））90天死亡率趋于更低（p = 0.078）。A组术后并发症发生率为63.2%（n = 12例），而B组为56.4%（n = 22例）（p = 0.316）。该队列中肺切除术后脓胸消退率为100%。A组3例患者（15.8%）和B组3例患者（7.7%）（p = 0.175）发生了脓胸复发，再次采用该治疗方案成功处理。A组平均住院时间较短（24.6±9.5天，而B组为27.2±24.3天；p = 0.329）。采用我们的加速治疗方案，伴有支气管胸膜瘘的肺切除术后脓胸能够在保持胸壁完整性的同时得到有效且安全的治疗。临床注册号：KEK-ZH-NR：2021-01114。
