小儿脓胸的外科治疗

Surgical treatment of pleural empyema in children

目的总结小儿脓胸的外科治疗经验,探讨小儿脓胸不同治疗方法的应用时机。方法对1993年6月～2006年1月期间我院收治的98例小儿脓胸进行回顾性研究分析。根据病程病情选择不同的治疗方法,其中行单纯胸腔穿刺治疗10例,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7例。结果所有病例均治愈出院,其中10例单纯行胸腔穿刺患儿中3例效果不佳再次行肋床引流,4例患儿胸腔闭式引流效果不佳改行肋床引流,2例患儿肋床引流后3个月再次行胸膜纤维板剥脱术。各组患者远期疗效良好。结论小儿脓胸一经诊断,尽早选择有效的方法充分引流脓液是提高治愈率的关键,不同治疗方法应用时机不同,只要病例选择合适,各种方法均能取得满意的治疗效果。

Objective To summarize the experience of surgical treatment of pleural empyema in children and to investigate the best intervention time of different surgical therapies. Methods From Jun. 1993 to Jan. 2006, 98 children with pleural empyema were treated surgically. Different surgical therapies were chosen depending on the phase of pleural empyema development. Ten children underwent thoracentesis. Thoracic close drainage was performed on 38 cases,and closed chest drainage by rib resection on 43 cases, decortication on 7 cases respectively. Results All the 98 children were cured. Among them, closed chest drainage by rib resection followed thoracentesis in 43 cases or thoracic close drainage in 3 cases, and decortication followed closed chest drainage by rib resection in 2 cases. The result of long term follow-up was satisfied. Conclusion After diagnosis, optimal therapeutic intervention should be applied as soon as possible. Children with pleural empyema can be successfully treated with early thoracentesis or thoracic close drainage for the free-flowing effusion, and closed chest drainage by rib resection or decortication of the visceral pleura for multiloculated effusion and advanced empyema.