肺膿瘍預測膿胸病人手術治療之預後

黃弘哲

doi:10.6833/CJCU.2009.00118

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肺膿瘍預測膿胸病人手術治療之預後

Lung Abscess Predict the Surgical Outcome in Patients with Pleural Empyema

黃弘哲 , Masters　　Advisor：陳宏一　　Co-advisor ：方信元

繁體中文 DOI： 10.6833/CJCU.2009.00118

肺膿瘍；膿胸； lung abscess ； empyema

Abstract │ Reference (137) │ Altmetrics

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Pleural empyema is one of the serious complications of pneumonia, which increases morbidity and mortality. The mortality of patients with pleural empyema is up to 20% and leads to a higher hospital cost and longer hospital stay. Lung abscess has previously been thought to be a rare condition of empyema and parapneumonic effusions.

We compared the clinical presentations and surgical results of patients with pleural empyema with and without lung abscesses. From January 2004 to December 2006, 259 patients with pleural empyema were diagnosed and received operation in our department. We recorded the following data: age, gender, clinical findings, chronology of initial signs, diagnoses, bacteriological and biochemical studies of pleural fluid, and radiologic and intra-operative findings.  The outcomes were compared to evaluate the correlationships exists between pleural empyema and lung abscess.

All early and late deaths were attributed to progressive uncontrolled sepsis in patients with pleural empyema.  The causes of pleural empyema included pneumonia or lung abscess (n = 239), lung cancer (n = 9), deep neck infection induced (n=1), post-traumatic empyema (n = 6) and post-operation complications (n = 4). 22 patients with lung abscess were diagnosed by the pre-operative image study or by the finding during operation.

All these patients received video-assisted thoracic surgery, but two operations（0.77％）were converted to mini-thoracotomy due to thick peel. There are statistic significant difference between abscess group and non-abscess group in pre-operative leukocytosis（95.45％ and 63.29％, P< 0.05）, transferred into intensive care unit（63.64％ and 40.08％, P<0.05）, mortality during 30 days after operation（18.18％ and 2.95％, P<0.05）and overall mortality（22.73％ and 5.91％, P<0.05）. Patients with lung abscess and pleural empyema may need more operations（40％ and 1.7％， P>0.05）.

The mortality is higher in pleural empyema patients with lung abscess, or without adequate drainage in time.  Patients with lung abscess and pleural empyema may need more operation procedures and need careful clinical observation and care.

Reference ( 137 ) 〈TOP〉

Agrenius V et al., Pleural fibrinolytic activity is decreased in inflammation as demonstrated in quinacrine pleurodesis treatment of malignant pleural effusion. Am Rev Respir Dis, 1989. 140(5): p. 1381-5.
連結：
Allewelt M, Schuler P, Bolcskei PL, et al, Ampicillin t sulbactam vs. clindamycin_cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin Microbiol Infect 2004; 10:163–170.
連結：
Anstadt MP, Guill CK, Ferguson ER, Gordon HS, Soltero ER, Beall AC, Musher DM, Surgical versus nonsurgical treatment of empyema thoracis: an outcomes analysis. Am J Med Sci 2003;326(1):9—14.
連結：
Athanassiadi K, Gerazounis M, Kalantzi N, Treatment of post-pneumonic empyema thoracis. Thorac Cardiovasc Surg 2003;51:338—41.
連結：
Barnes NP, Hull J, Thomson AH, Medical management of parapneumonic pleural disease. Pediatr Pulmonol 2005;39: 127–134
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