Galea J L, De Souza A, Beggs D, Spyt T
Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, Leicester, UK.
J R Coll Surg Edinb. 1997 Feb;42(1):15-8.
Empyema thoracis remains a common thoracic problem with challenging management strategies. We analysed retrospectively 107 consecutive patients treated for empyema thoracic over a 5-year period. The majority of patients (75%) were male with a mean age of 51 years. Common presenting symptoms were cough, dyspnoea, chest pain and pyrexia. The mean duration of pre-admission symptoms was 7.5 weeks. The causes of empyema were pneumonia, malignancy, iatrogenic injury and trauma. The most frequently isolated organism was Streptococcus milleri. In 71% of patients there was an underlying systemic disorder. Forty-nine patients (46%) underwent an unsuccessful therapeutic procedure prior to admission to the surgical units. In the units, 24 patients received closed intercostal chest tube drainage, 14 of whom required further intervention. Two patients were treated with repeated thoracocentesis. The majority of patients underwent a surgical procedure in the first instance: rib resection and drainage (5), decortication (22), and more extensive procedures (9) with only two patients requiring further surgery. The mean post-operative stay was 16 days and the hospital mortality was 13%. We recommend early referral of all empyema patients to thoracic units, where assessment and definitive procedures can be performed with high chances of success and moderate risk of morbidity and mortality.
脓胸仍然是一个常见的胸部问题，其治疗策略具有挑战性。我们回顾性分析了连续5年中接受脓胸治疗的107例患者。大多数患者（75%）为男性，平均年龄51岁。常见的临床表现为咳嗽、呼吸困难、胸痛和发热。入院前症状的平均持续时间为7.5周。脓胸的病因包括肺炎、恶性肿瘤、医源性损伤和创伤。最常分离出的病原体是米勒链球菌。71%的患者存在潜在的全身性疾病。49例患者（46%）在入住外科病房之前接受的治疗措施未成功。在病房中，24例患者接受了肋间闭式胸腔引流，其中14例需要进一步干预。2例患者接受了反复胸腔穿刺术。大多数患者首先接受了外科手术：肋骨切除及引流（5例）、胸膜剥脱术（22例）以及更广泛的手术（9例），只有2例患者需要再次手术。术后平均住院时间为16天，医院死亡率为13%。我们建议将所有脓胸患者尽早转诊至胸外科病房，在那里可以进行评估和确定性手术，成功几率高，发病和死亡风险适中。
