García-Yuste M, Ramos G, Duque J L, Heras F, Castanedo M, Cerezal L J, Matilla J M
Thoracic Surgery Service, University Hospital, Valladolid, Spain.
Ann Thorac Surg. 1998 Mar;65(3):818-22. doi: 10.1016/s0003-4975(97)01386-6.
The purpose of this study is to report our 15-year experience treating chronic empyemas after pulmonary resection and tuberculosis.
Open-window thoracostomy and thoracomyoplasty were used to treat 40 patients with chronic pleural empyema characterized by residual empyematic cavity, bronchopleural fistula, and persistent pleural infections that were secondary to tuberculosis (n = 22) or pulmonary resection (n = 18). Between 2 and 7 months after thoracostomy, thoracomyoplasty was performed to eliminate a persistent pleural cavity. In 2 patients with postpulmonary resection empyema and a large bronchopleural fistula, intrathoracic transposition of the latissimus dorsi flap and open-window thoracostomy were performed simultaneously to close the fistula.
The pleural space was eliminated per primam intentionem in 21 of 22 patients with tuberculosis and in 14 of 18 with a postpulmonary resection empyema. Another myoplasty was performed in an additional 3 patients to eliminate the pleural space. During open-window thoracostomy, the latissimus dorsi muscle was preserved with minimal injury to the anterior serratus muscle. One patient died postoperatively.
Successful treatment of chronic pleural empyema requires adequate timing of surgical procedures. Our two-procedure technique is relatively simple and safe.
本研究旨在报告我们治疗肺切除术后慢性脓胸及合并肺结核的15年经验。
采用开窗胸廓造口术和胸廓成形术治疗40例慢性胸膜脓胸患者，其特征为残留脓腔、支气管胸膜瘘以及继发于肺结核（n = 22）或肺切除（n = 18）的持续性胸膜感染。在胸廓造口术后2至7个月，进行胸廓成形术以消除持续性胸膜腔。对于2例肺切除术后脓胸且伴有大支气管胸膜瘘的患者，同时进行背阔肌皮瓣胸腔内移位和开窗胸廓造口术以闭合瘘口。
22例肺结核患者中有21例、18例肺切除术后脓胸患者中有14例一期成功消除胸膜腔。另外3例患者再次进行肌成形术以消除胸膜腔。在开窗胸廓造口术期间，背阔肌得以保留，前锯肌损伤最小。1例患者术后死亡。
成功治疗慢性胸膜脓胸需要手术时机恰当。我们的两步手术技术相对简单且安全。
