Martella A T, Santos G H
Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
J Am Coll Surg. 1995 May;180(5):573-6.
Thoracic empyema after pneumonia continues to be a source of morbidity and mortality. Despite the widespread use of antibiotics, more than 50 percent of empyemas are secondary to a primary pulmonary process. An empyema present for four to six weeks is considered chronic and can severely restrict the movement of the entire hemithorax.
Twenty-five adult patients with chronic, postpneumonic empyema required decortication at the Bronx Municipal Hospital Center between 1988 and 1990. Only patients with chronic postpneumonic empyema were included. All patients failed conservative treatment with antibiotics and tube drainage. Decortication was required to control infection and release the pulmonary entrapment.
Patients were often debilitated from alcoholism (52 percent), drug addiction (32 percent), and chronic disease. Ten patients (40 percent) required additional operative procedures to control infection: two pneumonectomies, three lobectomies, three wedge resections, and two debridements of pulmonary abscess were performed. Preoperative plain roentgenographs and computed tomographic scans diagnosed the empyema in all cases; however, they were frequently unable to predict the operative findings. There was one recurrence and one mortality (4 percent). The average postoperative period of hospitalization was 18 days (seven to 30 days).
Decortication remains a highly effective treatment for chronic postpneumonic empyema and may identify underlying complications that could account for a patient's poor response to conservative treatment. Pulmonary abscess and parenchymal necrosis may not be detected during preoperative evaluation.
肺炎后胸腔积脓仍然是发病和死亡的一个原因。尽管抗生素被广泛使用，但超过50%的胸腔积脓继发于原发性肺部疾病。持续四至六周的胸腔积脓被认为是慢性的，并且会严重限制整个半侧胸廓的活动。
1988年至1990年间，25例患有慢性肺炎后胸腔积脓的成年患者在布朗克斯市立医院中心接受了胸膜剥脱术。仅纳入患有慢性肺炎后胸腔积脓的患者。所有患者经抗生素和胸腔闭式引流的保守治疗均失败。需要进行胸膜剥脱术以控制感染并解除肺受压。
患者常因酗酒（52%）、药物成瘾（32%）和慢性病而身体虚弱。10例患者（40%）需要额外的手术操作来控制感染：实施了2例全肺切除术、3例肺叶切除术、3例楔形切除术和2例肺脓肿清创术。术前的普通X线片和计算机断层扫描在所有病例中均诊断出胸腔积脓；然而，它们常常无法预测手术结果。有1例复发和1例死亡（4%）。术后平均住院时间为18天（7至30天）。
胸膜剥脱术仍然是治疗慢性肺炎后胸腔积脓的一种非常有效的方法，并且可能识别出导致患者对保守治疗反应不佳的潜在并发症。术前评估可能无法检测到肺脓肿和实质坏死。
