Open Pleural Window at Treatment of the Advanced Thoracic Empyema: 20 High-risk Patients’ Treatment Experience
Authors:
V. Jedlička; P. Vlček; L. Veverková
; J. Doležel; A. Peštál; M. Veselý; J. Žák; I. Čapov
Authors place of work:
I. chirurgická klinika LF MU a FN u sv. Anny v Brně, přednosta: prof. MUDr. Ivan Čapov, CSc.
Published in the journal:
Rozhl. Chir., 2009, roč. 88, č. 5, s. 229-234.
Category:
Monothematic special - Original
Summary
The aim of the retrospective clinical study was the analysis of the 20 high-risk patients operated in our department within years 2000–2008 by the modified Eloesser procedure for the serious thoracic empyema.
Material and methods:
We have analyzed the data of the 17 men and 3 women. The most important objectives were the cause of the disease, type of procedure, perioperative mortality, length of stay and subsequent procedures. The underlying disease was the malignant intrathoracic disease in 40%, diabetes mellitus was found in 25%. The cause of empyema was pleuropneumonia in 45%, postresectional empyema occurred in 35%.
Results:
There were two perioperative deaths (10%), remaining patients were all dismissed in a stabilized condition the 22nd postoperative day at average. Six subsequent reconstructive procedures were performed. There was no early death for the postpneumonectomy empyema.
Conclusion:
In case of the serious pleural empyema in a high-risk patient is the modified Eloesser procedure safe and life saving surgical operation. The timing of the procedure and correct indication for surgery are essential.
Key words:
Open pleural window – thoracic empyema – mortality
Zdroje
1. Molnar, T. F. Current surgical treatment of thoracic empyema in adults. Eur. J. Cardio-thoracic. Surg., 2007; 32: 422–430.
2. Eloesser, L. A. An operation for tuberculous empyema. Surg. Gynecol. Obstet., 1935; 60:1096–1097.
3. Fry, W. A. Open drainage. In: Pearson, F. G., Cooper, J. D., Deslauriers, J., Ginsberg, R. J., Hiebert, C. A., Patterson, G. A., Urschel, H. C., Thoracic surgery. 2nd ed., Philadelpia, Churchill Livingstone, 2002: 1301–1307.
4. Eloesser, L. An operation for tuberculous empyema. Surg. Gynecol. Obstet., 1935; 60: 1096–1097.
5. Robinson, S. Open pleural drainage in a patient with thoracic empyema. Surg. Gynecol. Obstet., 1916; 22: 557–571.
6. Symbas, P. N., Nugent, J. T., Abbott, O. A., Logan, W. D., Hatcher, C. R. Jr. Nontuberculous pleural empyema in adults. Ann. Thorac. Surg., 1971; 12: 69–78.
7. Jacques, L. F., Deslauriers, J. Open drainage. In: Pearson, F. G., Deslauriers, J., Ginsberg, R., Hiebert, C. A., McKneally, M. F., Urschel, H. C. Jr., Thoracic surgery. New York: Churchill-Livingstone, 1995: 1136–1140.
8. Clagett, O. T., Geraci, J. E. A procedure for the management of postpneumonectomy empyema. J. Thorac. Cardiovasc. Surg., 1963; 45: 141.
9. Gharagozloo, F., Trachiotis, G., Wolfe, A., DuBree, K. J., Cox, James L. J. Pleural space irrigation and modified Clagett procedure for the treatment of the early postpneumonectomy empyema. Thorac. Cardiovasc. Surg., 1998; 116: 943–948.
10. Shamji, F. M., Ginsberg, R. J., Cooper, J. D., Spratt, E. H., Goldberg, M., Waters, P. F., Ilves, R., Todd, T. R., Pearson, F. G. Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula. J. Thorac. Cardiovasc. Surg., 1983; 86: 818–822.
11. Massera, F., Robustellini, M., Della Pona, C., Rossi, G., Rizzi, A., Rocc, G. Predictors of successful closure of open window thoracostomy for postpneumonectomy empyema. Ann. Thorac. Surg., 2006; 82: 288–292.
12. Šimek, M., Kaláb, M., Hájek, R., Zálešák, B., Molitor, M., Ječmínková, L., Grulichová, J., Gráfová, P., Němec, P. Vacuum-assisted closure v léčbě sternálních infekcí po kardiochirurgických výkonech. Nastal čas na změnu přístupu kardiochirurga? Hojení ran, 2007; 7: 4–11.
13. Segers, P., Kloek, J. J., Strackee, S. D., AJM de Mol, B. Open Window Thoracostomy: A new therapeutic option using topical negative pressure wound therapy. Wounds, 2007; 19: 264–269.
14. Vagač, M., Lábus, J., Korec, S. Některé aspekty chirurgické léčby plicní tuberkulózy torakoplastikou. Bratisl. Lek. Listy. 1962; 30; 491–499.
15. Hájek, M. Empyém hrudníku. Rozhl. Chir., 1985; 64: 403–405.
16. Hanke, I., Kysela, P., Benda, P., Hanslianová, M. Zkušenosti s léčbou empyému hrudníku během sedmiletého období. Rozhl. Chir., 2007; 86: 355–358.
17. Vyhnánek, F., Fanta, J., Jirava, D., Očadlík, M. Současný přístup v léčbě post-traumatického empyému hrudníku. Rozhl. Chir., 2006; 85: 14–18.
18. Špidlen,V. Chirurgická léčba empyému hrudníku. Rozhl. Chir., 1993; 72: 275–278.
19. Thourani, V. H., Lancaster, R. H., Mansour, K. A., Miller, J. I. Jr. Twenty-six years of experience with the modified Eloesser flap. Ann. Thorac. Surg., 2003;76: 401–406.
20. García-Yuste, M., Ramos, G., Duque, J. L., Heras, F., Castanedo,M., Cerezal, L. J., Matilla, J. M. Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann. Thorac. Surg., 1998; 65: 818–822.
21. Icard, P., Fleury, J. P., Regnard, J. F., Libert, J. M., Magdeleinat, P., Gharbi, N., Brachet, A., Levi, J. F., Levasseur, P. Utility of C-reactive protein measurements for empyema diagnosis after pneumonectomy. Ann. Thorac. Surg., 1994; 57, 933–936.
22. Lin, Y. C., Tu, C. Y., Chen, W., Tsai, Y. L., Chen, H. J., Hsu, W. H., Shih, C. M. An urgent problem of aerobic gram-negative pathogen infection in complicated parapneumonic effusions or empyemas. Intern. Med., 2007; 46: 1173–1178.
23. Luh, S. P., Chou, M. Ch., Wang, L. S. , Chen, J. Y., Tsai, T. P. Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: Outcome of 234 Patients. Chest, 2005; 127: 1427–1432.
24. Asamura, H., Naruke, T., Tsuchiya, R., Goya, T., Kondo, H., Suemasu, K. Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome. J. Thorac. Cardiovasc. Surg., 1992; 104: 1456–1464.
25. Darling, G. E., Abdurahman, A., Yi, Q. L., Johnston, M., Waddell, T. K., Pierre, A., Keshavjee, S., Ginsberg, R. Risk of a right pneumonectomy: role of bronchopleural fistula. Ann. Thorac. Surg., 2005; 79: 433–437.
26. Sirbu, H., Busch, T., Aleksic, I., Schreiner, W., Oster, O., Dalichau, H. Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management. Ann. Thorac. Cardiovasc. Surg., 2001; 7: 330–336.
27. Benej, R., Haruštiak, S., Bohucký, S. Racionálny prístup v liečbe empyéma hrudníka. Bratisl. Lek. Listy, 1995; 96: 279–282.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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