背景:胸膜脓胸与相关的发病率和死亡率有关,它可以被分类,根据进化和超声波,分为三个阶段:阶段I(自由流动积液),II期(粘性积液,倾向于定位),第三阶段(组织阶段)。根据指导方针,建议使用抗生素治疗和胸腔引流,当患者失败和/或有组织的脓胸时进行手术。
目的:本研究的目的是报告内科胸腔镜检查对胸部超声分层的胸膜脓胸患者的有效性和安全性。
方法:观察性回顾性队列研究分析内科胸腔镜治疗的胸膜脓胸患者。在手术后30天和90天评估手术成功率和死亡率;还报告了并发症。
结果:131例患者被纳入。此后,在大多数情况下进行了胸膜内纤溶治疗。在99例患者(76%)中,内科胸腔镜检查被认为是成功的,没有随后的干预;19例患者(15%)接受了第二次手术(引流,胸腔镜检查,电视辅助胸外科手术,或开胸手术);6例患者(5%)死于脓胸的演变。与III期治疗的患者相比,在I期和II期治疗的患者显示出明显更好的术后结果(100%,83.3%,58.1%,分别)。在18例患者中观察到胸腔镜检查并发症,并且在所有情况下都是可逆的。
结论:使用内科胸腔镜检查早期(自由流动或多部位积液)的胸膜脓胸患者的治疗效果明显优于晚期(有组织的脓胸)。这种方法是安全的,微创,对这些具有相关死亡率的疾病患者有效;然而,患者选择仍然至关重要。
Pleural empyema is associated with relevant morbidity and mortality, and it may be classified, according to evolution and ultrasound, into three stages: stage I (free-flowing effusion), stage II (viscous effusion with the tendency to loculate), and stage III (organizing phase). According to guidelines, antibiotic therapy and pleural drainage are recommended, with surgery being performed when patients fail and/or in case of organized empyema.
The aim of the study was to report the efficacy and safety of medical thoracoscopy in patients with pleural empyema stratified by chest ultrasound.
Observational retrospective cohort study analyzing patients with pleural empyema treated with medical thoracoscopy. Procedure success and mortality were evaluated at 30 days and 90 days after the procedure; complications were also reported.
131 patients were included. Intrapleural fibrinolytic therapy was performed thereafter in the majority of cases. Medical thoracoscopy was considered successful without subsequent intervention in 99 patients (76%); 19 patients (15%) underwent a second procedure (drainage, thoracoscopy, video-assisted thoracic surgery, or thoracotomy); and 6 patients (5%) died of the evolution of empyema. Patients treated in stages I and II showed significantly better post-procedure results compared with patients treated in stage III (100%, 83.3%, and 58.1%, respectively). Thoracoscopy complications were observed in 18 patients and were reversible in all cases.
Patients with pleural empyema treated in earlier stages (free-flowing or multiloculated effusion) with medical thoracoscopy show significantly better results than patients treated in later stages (organized empyema). This approach is safe, minimally invasive, and efficient in these patients with disease having relevant mortality; however, patient selection remains essential.