Abstract
Various surgical procedures have been developed in an attempt to alleviate the significant problems caused by chronic pleural empyema. The present study evaluates our 11-year experience of employing a number of therapeutic approaches for chronic empyema. Between 1987 and 1997, 45 consecutive patients underwent treatment for chronic empyema at our hospitals. They comprised 21 patients (47%) presenting with post-tuberculosis, 11 (24%) receiving cancer therapy including pulmonary resection, and 13 (29%) with postpneumonic empyema. Omentopexy, lung resection, and thoracoscopic surgery were performed in 10 (22%), 5 (11%), and 4 (9%) patients, respectively. Poor results of treatment were observed in two of the patients with post-tuberculous empyema, and three of the patients treated for cancer died of recurrence. The other 40 patients remain symptom-free. An improvement in quality of postoperative life was revealed by the exercise test rather than by static spirometry. Optimal therapy for chronic empyema requires selection of the most appropriate first and staged procedures for each patient. Moreover, lung resection should be minimal. In a critical state, open thoracostomy must be performed as the first procedure, while omentopexy or thoracoplasty should be restricted to selected cases. Dead space and minor air leakage may safely be left behind. A video-assisted procedure can be selected for postpneumonia empyema.
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References
Heffner JE, McDonald J, Barbieri C, Klein J (1995) Management of parapneumonic effusions: an analysis of physician practice patterns. Arch Surg 130:433–438
Muskett A, Burton NA, Karwande SV, Collins MP (1988) Management of refractory empyema with early decortication. Am J Surg 156:529–532
Blasco E, Paris F, Padilla J (1990) Acute postpneumonic empyema treated by intercostal tube drainage with suction and pleural washing but without rib resection. In Deslauriers J, Lacquet LK (eds) Thoracic surgery: surgical management of pleural disease. Mosby, St Louis, p 220
Lemmer JH, Botham MJ, Orringer MB (1985) Modern management of adult thoracic empyema. J Thorac Cardiovasc Surg 90:849–855
Varkey B, Rose HD, Kutty CPK, Politis J (1981) Empyema thoracis during a ten year period. Arch Intern Med 141:1771–1776
Elliott SE, Segger FG, Osborn JJ (1966) A modified oxygen gauge for the rapid measurement of PO2 in respiratory gases. J Appl Physiol 21:1672–1674
Sheffield LT, Roitman D (1976) Stress testing methodology. Prog Cardiovasc Dis 19:33–49
Striffeler H, Ris HB, Wursten HU, Im Hof V, Stirnemann P, Althaus U (1994) Videoassisted thoracoscopic treatment of pleural empyema. A new therapeutic approach. Eur J Cardiothorac Surg 8:585–588
Mackinlay TA, Lyons GA, Chimondeguy DJ, Piedras MA, Angamaro G, Emery J (1996) VATS debridement versus thoracotomy in the treatment of loculated postpneumonia empyema. Ann Thorac Surg 61:1626–1630
Okdaa M, Tsubota N, Yoshimura M, Miyamoto Y (1998) Surgical approach for multiple primary lung carcinomas. J Thorac Cardiovasc Surg 115:836–838
Okdad M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H, Satake S, Yamagishi H (1999) Extended sleeve lobectomy for lung cancer: the avoidance of pneumonectomy. J Thorac Cardiovasc Surg 118:710–714
Williams R, White H (1986) The greater omentum: its applicability to cancer surgery and cancer therapy. In: Ravitch MM (ed) Current problems in surgery. Year Book Medical, Chicago, p 818
Tsubota N, Yoshimura M, Murotani A, Miyamoto Y, Maniwa Y (1993) Results of surgical treatment for calcified tuberculous empyema: improved pulmonary function obtained with lung preserving policy. Tohoku J Exp Med 171:235–242
Okada M, Tsubota N, Yoshimura M, Kubota M, Murotani A (1993) The unusual development of empyema with multiple alveolobronchiolar fistulae 8 years after non-curative resection and radiation for lung cancer. Surg Today 23:1085–1088
Tsubota N, Hatta T, Yoshimura M, Yanagawa M (1991) A case of empyema developing thirteen years after a pneumonectomy treated using pedicled omentum which was followed by intestine obstruction. Jpn J Surg 21:703–705
Tsubota N, Yanagawa M, Yoshimura M, Murotani A, Hatta T, (1994) The superiority of exercise testing over spirometry in the evaluation of postoperative lung function for patients with pulmonary disease. Surg Today 24:103–105
Okada M, Ota T, Okada M, Matsuda H, Okada K, Ishii I (1994) Right ventricular dysfunction after major pulmonary resection. J Thorac Cardiovasc Surg 108:503–511
Okada M, Okada M, Ishii N, Yamashita C, Sugimoto T, Okada K, Yamagishi H, Yamashita T, Matsuda H (1996) Right ventricular ejection fraction in the preoperative risk evaluation of pulmonary resection candidates. J Thorac Cardiovasc Surg 112: 364–370
Rao V, Todd TR, Kuus A, Buth KJ, Pearson FG (1995) Exercise oximetry versus spirometry in the assessment of risk prior to lung resection. Ann Thorac Surg 60:603–608
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Okada, M., Tsubota, N., Yoshimura, M. et al. Surgical treatment for chronic pleural empyema. Surg Today 30, 506–510 (2000). https://doi.org/10.1007/s005950070116
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DOI: https://doi.org/10.1007/s005950070116