Ali S M, Siddiqui A A, McLaughlin J S
Department of Surgery, Aga Khan University, Karachi, Pakistan.
Ann Thorac Surg. 1996 Jul;62(1):218-23; discussion 223-4. doi: 10.1016/0003-4975(96)00298-6.
This study examined the results of open drainage of massive tuberculous empyema.
During a 7-year period 47 patients with primary mixed chronic tuberculous empyema with near or total lung collapse were treated. The initial procedure was chest tube suction drainage, which permitted evaluation of the pleural cavity and the lung parenchyma despite minimal if any reexpansion of the lung. All patients were treated with antibiotics and multidrug regimens of antituberculosis agents. A pleurocutaneous window was established by removing sections of two ribs one intercostal space above the base of the pleural cavity. Irrigation was performed daily with dilute povidone iodine solution.
Twenty-eight patients achieved complete reexpansion of the lung after 4 to 30 months of drainage and are cured. Eleven are in various stages of reexpansion and probably will be cured. Eight patients did not achieve reexpansion. Criteria were established retrospectively on an ongoing basis that indicate when pulmonary reexpansion is possible.
These totally collapsed "entrapped" lungs expanded to fill the entire pleural space despite the presence of bronchopleural fistulas and an "open" pleura. Reexpansion was progressive, gradual, and dependent on improved compliance, clearing of bronchial inflammation and obstruction, and pleural cleansing. Criteria are established that identify those patients in whom complete reexpansion may take place and the disease may be cured.
本研究探讨了大量结核性脓胸开放引流的结果。
在7年期间，对47例原发性混合性慢性结核性脓胸且肺近全萎陷或全萎陷的患者进行了治疗。初始操作是胸腔闭式引流，尽管肺复张极少或未复张，但仍可对胸腔和肺实质进行评估。所有患者均接受抗生素及多种抗结核药物联合治疗。通过切除胸腔底部上方一个肋间的两根肋骨部分建立胸膜皮肤造口。每天用稀释的聚维酮碘溶液进行冲洗。
28例患者在引流4至30个月后肺完全复张并治愈。11例患者处于不同阶段的复张过程中，可能会治愈。8例患者未实现复张。在治疗过程中回顾性地制定了一些标准，以判断何时肺有可能复张。
尽管存在支气管胸膜瘘和“开放”的胸膜，但这些完全萎陷的“包裹性”肺仍能扩张以填满整个胸腔。肺复张是渐进性的、逐渐的，且依赖于顺应性改善、支气管炎症和阻塞的清除以及胸膜清洁。已制定标准来识别那些可能实现完全复张且疾病可能治愈的患者。
