Optimal Timing of Thoracoscopic Drainage and Decortication for Empyema
Optimal Timing of Thoracoscopic Drainage and Decortication for Empyema
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DOI：
10.1016/j.athoracsur.2013.08.039
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发表时间：
2014-01-01
影响因子：
4.6
通讯作者：
Sun, Kyung
中科院分区：
文献类型：
--
作者：
Chung, Jae Ho;Lee, Sung Ho;Sun, Kyung
背景虽然电视胸腔镜手术（VATS）胸腔引流和胸膜剥脱术已被证明是治疗早期脓胸的有效方法，但VATS的最佳时机仍不清楚。为了评估早期胸腔镜引流和剥脱术的有效性，我们回顾了接受胸腔镜和开放性剥脱术治疗脓胸的患者的记录。128例脓胸患者在韩国大学Anam医院接受了8年多的电视胸腔镜手术和开放式剥脱术治疗。将120例VATS患者根据胸部症状发作与手术时间的间隔分为3组（第1组：4周）。另外8例症状持续时间超过4周的开放性皮质剥脱患者与第3组患者进行了比较。与第3组相比，第1组和第2组的胸管留置时间、术后住院时间、外科手术时间更短，长期漏气更少。第1组和第2组之间无显著差异; 3组之间的术后重症监护室停留时间或再干预和再手术率均无差异。在慢性脓胸患者中，第3组的胸管留置时间短于开放式剥脱术组。症状持续时间小于4周的患者比症状持续时间大于4周的患者显示出更好的早期结果。因此，症状持续时间可以被认为是一个可靠的术前因素，在决定手术治疗脓胸或案件涉及分叶状胸腔积液。(C)2014年由胸外科医师协会
Background. Although video-assisted thoracic surgery (VATS) pleural drainage and decortication have been proven to be effective treatments in the early stages of empyema, the optimal timing of VATS is still not clear. To assess the effectiveness of early VATS drainage and decortication, we reviewed the records of patients who underwent VATS and open decortication for empyema.Methods. One hundred twenty-eight patients with empyema were treated with VATS and open decortication over 8 years at Korea University Anam Hospital. The VATS patients (120 patients) were divided into 3 groups based on the interval between the onset of chest symptoms and the time of operation (group 1: 4 weeks). Additional 8 open decortication patients with symptom durations greater than 4 weeks were compared with group 3 patients.Results. Groups 1 and 2 showed shorter chest tube duration, postoperative hospital stay, surgical procedure time, and fewer prolonged air leaks than group 3. No significant difference was noted between groups 1 and 2; and no difference was noted in the length of postoperative intensive care unit stays or the reintervention and reoperation rates among the 3 groups. In chronic empyema patients, group 3 showed shorter chest tube duration than the open decortication group.Conclusions. Patients with symptom durations of less than 4 weeks showed better early results than those with symptom durations greater than 4 weeks. Thus, symptom duration can be considered a reliable preoperative factor in deciding the surgical management of empyema or cases involving loculated pleural effusion. (C) 2014 by The Society of Thoracic Surgeons