Kull C, Hunger T, Widmer M K, Rittmann W W
Chirurgische Klinik, Kantonsspital Liestal.
Swiss Surg. 1996;2(5):191-5.
Thoracoscopic treatment of pleural empyema is still a controversial method, especially in the chronic stage of the disease. The issue is raised whether the thoracoscopic approach to the empyema-possibly combined with a small additional thoracotomy in advanced stages-is successful and of low risk.
Between January 1993 and May 1995 we treated 13 patients in advanced stages of pleural empyema. The patients were all seriously ill and had severe underlying disease. The procedures were performed under general anesthesia involving intubation with a double-lumen endotracheal tube. The steps of our standard operative procedure are outlined.
In 5 patients with a pleural empyema in stage III thoracoscopy was facilitated by a small additional thoracotomy. A complete resolution of the disease was obtained in 12 cases and a secondary intervention was necessary in 1 patient. There was no peri- or postoperative mortality, and apart from a prolonged drainage of the pleural cavity in 3 patients no morbidity was registered. In the long-term follow up, 3 patients had died. There was no correlation between the deaths and the intervention or the empyema disease.
We discuss the advantages of a limited additional thoracotomy in case of intraoperative difficulties encountered with late stages of empyema. This treatment can still be considered minimally invasive. All patients tolerated the procedure well, and the overall results were favourable in 92% of our collective. However, thoracoscopic treatment should preferably take place at an earlier stage.
We recommend the thoracoscopic approach-possibly combined with a limited thoracotomy-as primary treatment in late stages of pleural empyema.
胸腔镜治疗脓胸仍是一种存在争议的方法，尤其是在疾病的慢性阶段。问题在于，胸腔镜治疗脓胸（在晚期可能联合小切口开胸手术）是否成功且风险较低。
1993年1月至1995年5月期间，我们治疗了13例晚期脓胸患者。这些患者病情均较重且伴有严重的基础疾病。手术在全身麻醉下进行，采用双腔气管插管。概述了我们标准手术操作的步骤。
5例Ⅲ期脓胸患者通过小切口开胸手术辅助胸腔镜检查得以顺利进行。12例患者疾病完全缓解，1例患者需要二次干预。围手术期及术后均无死亡病例，除3例患者胸腔引流时间延长外，无其他并发症记录。长期随访中，3例患者死亡。死亡与手术干预或脓胸疾病之间无相关性。
我们讨论了在脓胸晚期术中遇到困难时有限增加开胸手术的优势。这种治疗仍可被视为微创治疗。所有患者对手术耐受性良好，总体结果在我们的病例组中92%良好。然而，胸腔镜治疗最好在疾病早期进行。
我们推荐胸腔镜治疗（可能联合有限开胸手术）作为晚期脓胸的主要治疗方法。
