67例纤维脓性胸腔脓胸的电视辅助胸腔镜手术

Video-assisted thoracoscopic surgery for fibrinopurulent pleural empyema in 67 patients.

作者信息

Striffeler H, Gugger M, Im Hof V, Cerny A, Furrer M, Ris H B

机构信息

Department of Thoracic and Cardiovascular Surgery, University of Bern, Inselspital, Switzerland.

出版信息

Ann Thorac Surg. 1998 Feb;65(2):319-23. doi: 10.1016/s0003-4975(97)01188-0.

DOI:10.1016/s0003-4975(97)01188-0

PMID:9485221

Abstract

BACKGROUND

The roles of different drainage procedures in the management of empyema have to be redefined now that video-assisted thoracoscopic surgery (VATS) has been introduced. The debridement of fibrinopurulent stage II empyema with the use of VATS was assessed prospectively in regard to control of infection and restoration of pulmonary function.

METHODS

Between January 1992 and May 1996, all patients at our institution with fibrinopurulent empyema that did not respond to chest tube drainage and antibiotic therapy were treated by debridement with the use of VATS. The patients were followed up prospectively by clinical and radiologic assessments 3 and 6 months after the operation and by spirometry 6 months after the operation.

RESULTS

Video-assisted thoracoscopic surgery was initiated in 67 patients, but conversion to open decortication was required because of the finding of advanced disease in 19 patients (28%). Forty-eight patients underwent successful debridement with the use of VATS. The mean operative time was 82.1 minutes (range, 50 to 135 minutes), the mean duration of postoperative chest tube placement was 4.1 days (range, 2 to 8 days), and the mean duration of postoperative hospitalization was 12.3 days (range, 4 to 42 days). No wound infections were observed during the postoperative course. Both the 30-day mortality rate and the recurrence (ie, need for thoracotomy) rate were 4%. The mean predicted vital capacity was 84.8% +/- 14.9% and the mean predicted forced expiratory volume in 1 second was 88.6% +/- 19.2% 6 months after the operation.

CONCLUSIONS

Debridement with the use of VATS is safe and efficient for stage II empyema, but open decortication should be used for more advanced disease.

摘要

背景

鉴于电视辅助胸腔镜手术（VATS）已被应用，不同引流方法在脓胸治疗中的作用必须重新定义。我们对使用VATS清除纤维脓性期II型脓胸进行了前瞻性评估，以观察其对感染控制及肺功能恢复的效果。

方法

1992年1月至1996年5月，我院所有对胸腔闭式引流及抗生素治疗无效的纤维脓性脓胸患者均接受了VATS清创治疗。术后3个月和6个月对患者进行临床及影像学前瞻性随访，并在术后6个月进行肺功能测定。

结果

67例患者接受了VATS手术，但19例（28%）因病情进展需转为开胸剥脱术。48例患者成功接受了VATS清创术。平均手术时间为82.1分钟（范围50至135分钟），术后胸腔闭式引流平均放置时间为4.1天（范围2至8天），术后平均住院时间为12.3天（范围4至42天）。术后过程中未观察到伤口感染。30天死亡率和复发率（即再次开胸手术的需要）均为4%。术后6个月，平均预计肺活量为84.8%±14.9%，平均预计第1秒用力呼气量为88.6%±19.2%。