Khakoo G A, Goldstraw P, Hansell D M, Bush A
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.
Pediatr Pulmonol. 1996 Dec;22(6):348-56. doi: 10.1002/(SICI)1099-0496(199612)22:6<348::AID-PPUL3>3.0.CO;2-F.
The management of parapneumonic empyema remains controversial. We present the management of 20 children with empyema who were referred to The Royal Brompton Hospital, over a 5-year period from January 1990 to December 1994. Prior to referral, only 12 of the 20 patients had undergone thoracocentesis, all confirming the diagnosis of empyema. Six of these 12 patients then underwent closed chest tube drainage. There was a 2 to 32 day (median, 8 days) delay from initial hospital presentation to referral. Following referral 13 of the 20 patients were assessed as having persistence of clinical symptoms and radiological appearances making recovery with continued conservative management unlikely. These patients had a thoracotomy with decortication within 2 days. The remaining 7 were initially treated with closed chest tube drainage, but 5 subsequently required decortication. All patients made an uneventful postoperative recovery and were discharged within 3-11 days (mean. 6.8 days) Four patients were subsequently found to have a significant underlying immunological defect We conclude that there is a lack of agreement regarding the initial management of parapneumonic empyema. In our experience, decortication gives excellent results in those children not responding to medical treatment within 7-0 days. In experienced hands this technique is safe with rapid resolution. All patients who present with empyema should be screened for immunological abnormalities.
肺炎旁胸腔积液的治疗仍存在争议。我们介绍了1990年1月至1994年12月这5年间转诊至皇家布朗普顿医院的20例胸腔积液患儿的治疗情况。转诊前，20例患者中只有12例接受了胸腔穿刺术，均确诊为胸腔积液。这12例患者中有6例随后接受了闭式胸腔引流。从最初入院到转诊的延迟时间为2至32天（中位数为8天）。转诊后，20例患者中有13例经评估存在临床症状和影像学表现持续存在的情况，继续保守治疗不太可能康复。这些患者在2天内接受了开胸剥脱术。其余7例最初接受闭式胸腔引流治疗，但其中5例随后需要进行剥脱术。所有患者术后恢复顺利，在3至11天（平均6.8天）内出院。4例患者随后被发现存在明显的潜在免疫缺陷。我们得出结论，对于肺炎旁胸腔积液的初始治疗缺乏共识。根据我们的经验，对于在7至10天内对药物治疗无反应的儿童，剥脱术能取得极佳的效果。在经验丰富的医生手中，这项技术安全且能迅速解决问题。所有胸腔积液患者都应筛查免疫异常情况。
