小儿脓胸的不同手术方法的应用时机选择及疗效比较

Selection and their curative effects of different surgical procedures for pleural empyema in children

目的:比较胸腔闭式引流术、肋床引流术和胸膜纤维板剥脱术对小儿脓胸的临床治疗效果,探讨其不同的应用时机。方法:我院采用不同外科方法治疗小儿脓胸88例。其中行胸腔闭式引流术38例,行肋床引流术43例,行胸膜纤维板剥脱术7例。对其术前病程、胸腔积液量、积液有无包裹、术中平均引流量、术后平均引流量、术后平均引流时间、术后平均住院时间、平均总住院时间以及治愈率进行分析。结果:术前病程、积液包裹与手术方法的选择有密切相关性。胸膜纤维板剥脱术在术中平均引流量、术后平均引流量、术后平均引流时间较胸腔闭式引流术和肋床引流术少。胸腔闭式引流术后平均引流量较肋床引流术更多,其他指标相当。3种手术方法比较,术中术后输血量差异明显,治愈率无明显差异。结论:胸腔闭式引流、肋床引流和胸膜纤维板剥脱治疗小儿脓胸均可获得满意的结果。早期胸腔闭式引流术创伤最小,但应根据患儿术前病程、胸腔积液量、积液包裹选择不同的手术方法。

Objective：To compare the clinical outcomes of thoracic close drainage, closed chest drainage by rib resection, and decortication in treatment of pleural empyema in children, and to investigate the best intervention time for different surgical procedures. Methods： From Jun. 1993 to Jan. 2006, 88 children with pleural empyema were treated surgically. Thoracic close drainage was performed on 38 patients; closed chest drainage by rib resection, on 43 patients; and decortication,on 7 patients respectively. Different surgical therapies were choosen depending on the phase of pleural empyema development. We analyzed the preoperative course of disease, the quantity of pleural effusion, effusion encapsulation, the drainage quantity during operation, average postoperative drainage quantity, average duration of drainage, average postoperative length of hospitalization, average full length of hospitalization and the cure rate. Results： The preoperative course and effusion encapsulation were significantly correlated with surgical procedure selection. Decortication had less average drainage during operation or afteroperation, and shorter postoperative drainage duration than thoracic close drainage or closed chest drainage by rib resection. Thoracic close drainage had more postoperative drainage than closed chest drainage by rib resection.The three surgical procedures had similar cure rate with the quantity of average operative and postoperative blood transfusion significantly different. Conclusion： Children with pleural empyema can be successfully treated by thoracic close drainage, closed chest drainage by rib resection or decortication. Though early thoracic close drainage has the least trauma, the three surgical procedures should be appropriately applied according to preoperative course, pleural effusion amount and effusion encapsulation.