胸膜纤维层剥脱术治疗慢性脓胸113例

摘要

Objective To summarize the treatment of chronic empyema with decortication in 113 patients. Methods Data of 113 cases with chronic empyema underwent decortication were analyzed retrospectively,of whom 71(62%) cases had chronic tuberculous empyema and 42(38%) cases suffered from bacteria empyema with different causes. Results All the patients were successfully treated with decortication without perioperative death. Re-thoracotomy was taken to stop bleeding in 2 cases. Wound healing delay due to tuberculosis infection was seen in 3 cases. Conclusion Decortication is an effective treatment for chronic empyema. For tuberculous empyema, decortication can eliminate the source of infection and prevent chest wall tuberculosis. The most difficult issues in decortication are separation of the visceral pleura in post-haematothorax empyema and massive bleeding during surgical treatment of tuberculous empyema. The key points are the appropriate approaches and the complete elimination of vomica. Lung resection or thoracoplasty is needed in some cases to achieve the best surgical results.%目的 探讨胸膜纤维层剥脱术治疗慢性脓胸的围手术期处理要点.方法 回顾性分析113例胸膜纤维层剥脱术的临床资料.其中,结核性慢性脓胸71例(62％),其他普通菌脓胸42例(38％).结果 113例均治愈,无围手术死亡.术后再次剖胸止血2例,切口结核感染致切口延迟愈合3例.结论 完整胸膜纤维层剥脱术是治疗慢性脓胸的最佳治疗术式.对结核性病变可消灭感染源,防止发生胸壁结核.血胸所致慢性脓胸时脏层胸膜难以剥离.结核性病变时术中大量渗血是最大难点,选择合适的剥离径路、彻底清除脓腔是关键;必要时应同时行相应的肺切除或胸廓成形术以确保最佳手术效果.