带蒂肌瓣转位治疗肺脓疡合并脓气胸的临床研究

Clinical study on the treatment of pulmonary abscess complicated with pneumothorax by pedicled muscle flap transposition

目的:探讨带蒂肌瓣转位治疗肺脓疡合并脓气胸的可行性。方法:分析2019年6月至2021年6月在武汉大学中南医院胸外科行带蒂肌瓣转位修复治疗纤维板剥脱后肺脓疡破溃形成大的漏气创面的5例肺脓疡合并脓气胸患者术后恢复情况,观察术后1、4、7 d白细胞(WBC)、降钙素原(PCT)、白细胞介素(IL)-6表达情况,及术后随访情况。结果:所有患者术后发热、咳嗽咳痰等症状较术前明显好转,术后7 d内WBC、PCT、IL-6逐渐降至正常范围,术后随访无脓胸复发。结论:肺脓疡合并脓气胸纤维板剥脱后就近带蒂肌瓣转位修复肺漏气创面,简单有效,疗效确切,值得临床推广。

Objective: To investigate the feasibility of transposition of pedicled muscle flap in the treatment of pulmonary abscess complicated with empyema pneumothorax. Methods: The postoperative recovery of 5 patients with pulmonary abscess complicated by pyopneumothorax was analyzed retrospectively, who were treated with pedicled muscle flap transposition in Dept. of Thoracic Surgery,Zhongnan Hospital of Wuhan University from June 2019 to June 2021. The levels of white blood cells count(WBC), procalcitonin(PCT), and interleukin(IL)-6 on the 1st, 4th, and 7th days after operation were analyzed, and all cases were follow-up for two months. Results: The symptoms such as fever, cough, and expectoration were significantly improved after operation. WBC, PCT, and IL-6 levels gradually decreased to normal range in 7 days after operation. There was no recurrence of pyothorax during follow-up. Conclusion: For pulmonary abscess complicated by pneumothorax, fiberboard decortication and pedicled muscle flap transposition could repair pulmonary air leakage wound,and the procedures are simple and effective for thoracic surgeons.