小儿脓胸手术时机的探讨

Study on operative opportunity for infantile empyema

目的:研究小儿脓胸经保守治疗后多长时间选择手术治疗为佳。方法:72例患儿分为两组。Ⅰ组手术时间在60天以上,Ⅱ组手术时间在35天以内。结果:除13例保守治愈外,两组均应用抗生素,行胸膜腔穿刺和胸腔闭式引流失败后再行扩清术。通过术中出血量、纤维板厚度、手术时间、术后应用抗生素时间和术后出院时间对比,两组有极显著性差异(P<0.001)。结论:小儿脓胸以金黄色葡萄球菌感染者占首位。此种细菌早期即形成粘稠脓汁、多房性脓腔和纤维包膜,是保守治疗失败的主要原因,应早期行扩清术。此术式是简单、安全和有效的方法。

Objective: To sdudy the optimal operative opportunity for infantile cmpycma after conservative treatment. Methods: 72 children with empyma were divided into 2 groups. The opera-tive time was arranged over 60 days and within 35 days after beginning the conservative treatment in groups I and Ⅱ respectively. Results: Because of failed antibiotic therapy, thoracoccntcsis, and closed thoracic drainage, dcbridemcnt and dccortication were done in all except 13 cases who were cured by conservative thrcatmcnt. Group I was compared with group Ⅱ in amount of intraopcrativc bleeding, thickness of fibroclastic peel, operative duration and days of antibiotic therapy and hospitali-ation following the operation, there was statistically significant difference between them( P <0. 001). Conclusion: This study showed that infantile cmpycma is mainly caused by staphylococcus aurcus. In early stage of infection, the bacteria can produce a viscoxus pus, multilocular pus-cavity and fibroelastic peel, which arc responsible for failed conservative treatment. Dcbridemcnt and dccortica-tion should be done as early as possible. This operation is simple, safe and effective way.