Eren N, Ozçelic C, Ener B K, Ozgen G, Solak H, Balci A E, Tas S
Department of Thoracic and Cardiovascular Surgery, Dicle University, School of Medicine, Diyarbakir, Turkey.
Scand J Thorac Cardiovasc Surg. 1995;29(3):125-9. doi: 10.3109/14017439509107218.
Early pulmonary decortication was performed on 66 of 137 children with postpneumonic empyema, while 71 received conventional treatment. The mean age of the 66 patients with decortication was 5.5 years (range 6 months-14 years). The empyema was left-sided in 34 and right-sided in 32. Decortication was performed when lung expansion was not obtained after 10-12 days of intercostal tube drainage, antibiotic therapy (guided by sensitivity tests of pleural fluid) and pleural irrigation. Scintigraphy showed loss of pulmonary perfusion on the side of empyema to be 65% +/- SD 20 (25-98)% before decortication in the 23 tested patients. In ten of them the test was repeated after surgery and showed significant (p < 0.001) diminution of the perfusion defect, from 57 +/- 6.8 (25-84)% to 4 +/- 2.6 (0-8)%. The hospital stay was significantly (p < 0.001) shorter for the surgically treated than for the classically managed patients, viz. 19.5 +/- 4 (13-36) days vs 73.6 +/- 14 (34-110) days. Early decortication thus had beneficial effects on pulmonary perfusion and hospital stay.
137例肺炎后脓胸患儿中，66例接受了早期肺剥脱术，71例接受了传统治疗。66例接受剥脱术患儿的平均年龄为5.5岁（范围6个月至14岁）。脓胸位于左侧34例，右侧32例。当肋间置管引流、抗生素治疗（根据胸水药敏试验指导）和胸腔冲洗10 - 12天后肺仍未复张时，进行剥脱术。23例接受检查的患者在剥脱术前核素扫描显示脓胸侧肺灌注缺损为65%±标准差20（25 - 98）%。其中10例术后复查，灌注缺损从57±6.8（25 - 84）%显著（p < 0.001）减少至4±2.6（0 - 8）%。手术治疗患者的住院时间显著（p < 0.001）短于传统治疗患者，分别为19.5±4（13 - 36）天和73.6±14（34 - 110）天。因此，早期剥脱术对肺灌注和住院时间有有益影响。
