Postpneumonectomy empyema. The role of intrathoracic muscle transposition.
Postpneumonectomy empyema. The role of intrathoracic muscle transposition.
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肺切除术后脓胸。
DOI：
10.1016/s0022-5223(20)31451-3
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
P. Kay
中科院分区：
文献类型：
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作者：
P. Pairolero;P. G. Arnold;V. Trastek;N. Meland;P. Kay
45名患者（36名男性和9名女性）接受了肺切除术后脓胸治疗。所有患者最初均采用Clagett手术的第一阶段（开放性胸膜引流）进行治疗。在28例伴有支气管胸膜瘘的患者中，在开放引流时用肌肉移位术闭合并加固瘘口。7名患者有多个皮瓣。前锯肌移位28例，背阔肌移位11例，胸大肌移位4例，胸小肌移位1例，腹直肌移位1例。在瘘管闭合且胸膜腔清洁后，进行Clagett手术的第二阶段（用抗生素溶液闭塞胸膜腔并闭合开放的胸膜窗）。手术次数范围为1 - 19次（中位数5.0）。住院时间范围为4至137天（中位数34.0天）。有6例手术死亡（死亡率为13.3%），在两个阶段的Clagett手术的患者中没有死亡。39例手术存活者的随访时间范围为2.1至90.2个月（中位数21.8个月）。84%完成Clagett手术的患者（26/31）胸壁愈合，无复发感染证据。85.7%（24/28）的患者支气管胸膜瘘保持闭合。有19例晚期死亡，均与肺切除术后脓胸无关。我们的结论是，Clagett程序仍然是安全和有效的管理肺切除术后脓胸在没有支气管胸膜瘘和胸内肌肉移位，以加强支气管残端是一个有效的程序，在控制肺切除术后相关的支气管胸膜瘘。
Forty-five patients (36 male and nine female) were treated for postpneumonectomy empyema. All were initially managed with the first stage of the Clagett procedure (open pleural drainage). In 28 patients with associated bronchopleural fistula the fistula was closed and reinforced with muscle transposition at the time of open drainage. Seven patients had multiple flaps. The serratus anterior muscle was transposed in 28 patients, latissimus dorsi in 11, pectoralis major in four, pectoralis minor in one, and rectus abdominis in one patient. After the fistula was closed and the pleural cavity was clean, the second stage of the Clagett procedure (obliteration of the pleural cavity with antibiotic solution and closure of the open pleural window) was done. The number of operative procedures ranged from 1 to 19 (median 5.0). Length of hospitalization ranged from 4 to 137 days (median 34.0 days). There were six operative deaths (mortality rate 13.3%), none in the patients who had both stages of the Clagett procedure. Follow-up of the 39 operative survivors ranged from 2.1 to 90.2 months (median 21.8 months). Eighty-four percent of patients in whom the Clagett procedure was completed (26/31) had a healed chest wall with no evidence of recurrent infection. The bronchopleural fistula remained closed in 85.7% of patients (24/28). There were 19 late deaths, none related to postpneumonectomy empyema. We conclude that the Clagett procedure remains safe and effective in the management of postpneumonectomy empyema in the absence of bronchopleural fistula and that intrathoracic muscle transposition to reinforce the bronchial stump is an effective procedure in the control of postpneumonectomy-associated bronchopleural fistula.