Ferguson M K
Department of Surgery, University of Chicago Medical Center, IL 60637.
Ann Thorac Surg. 1993 Sep;56(3):644-5. doi: 10.1016/0003-4975(93)90938-e.
The management of complications affecting the pleural space is sometimes technically demanding, but has been enhanced by the recent introduction of thoracoscopic techniques. An empyema in the fibrinopurulent phase is best managed by disruption of the loculations and complete drainage of the infected space. This is easily accomplished with the use of thoracoscopy, which also permits inspection of the pleural space to determine whether additional surgical intervention is required. In contrast, thoracoscopy is not indicated in the management of a free-flowing empyema or a chronic empyema associated with a fibrous capsule. Bronchopleural fistulas are occasionally treated by thoracostomy tube drainage alone, but, in most situations, surgical intervention is necessary to permit reclosure of the bronchus, coverage of the stump with vascularized tissue, and decortication or tissue flap rotation to fill the pleural space. These maneuvers are beyond the capabilities of current thoracoscopic techniques. Chylothorax is best treated initially by intercostal tube drainage and supportive measures. When surgical intervention is necessary to directly close a lymph vessel leak, thoracoscopic techniques have been successful in effecting closure, according to anecdotal reports.
影响胸膜腔并发症的处理有时在技术上要求较高，但最近胸腔镜技术的引入使其得到了改进。纤维脓性阶段的脓胸最好通过分隔的破坏和感染腔的彻底引流来处理。使用胸腔镜很容易做到这一点，胸腔镜还可以检查胸膜腔，以确定是否需要额外的手术干预。相比之下，胸腔镜不适用于处理自由流动的脓胸或与纤维包膜相关的慢性脓胸。支气管胸膜瘘偶尔仅通过胸腔造瘘管引流治疗，但在大多数情况下，需要手术干预以重新闭合支气管，用带血管组织覆盖残端，并进行胸膜剥脱或组织瓣旋转以填充胸膜腔。这些操作超出了当前胸腔镜技术的能力范围。乳糜胸最初最好通过肋间置管引流和支持措施进行治疗。根据一些传闻报道，当需要手术干预直接闭合淋巴管漏时，胸腔镜技术已成功实现闭合。
