Single-port video-assisted thoracoscopic surgery in the management of fibrinopurulent empyema: the experience of a single institution

IF 2.5 Q4 Medicine Minerva Pneumologica Pub Date : 2019-02-01 DOI:10.23736/S0026-4954.19.01841-8

Abdoulhossein Davoodabadi, Mohammed Alisaba, H. Adeli, Mojtaba Sehhat, M. Najafi

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引用次数: 1

Abstract

BACKGROUND: Acute thoracic empyema requires appropriate diagnosis of the disease stage and on time management. The best time of surgical intervention and treatment options of the fibrinopurulent stage empyema is not precisely determined. This study aimed at assessing the effect of a single-port video-assisted thoracoscopic surgery (VATS), as the first option thorough previous chest tube incision, on management of acute thoracic empyema in the fibrinopurulent stage. METHODS: This cross-sectional, prospective, study was performed on 62 patients with fibrinopurulent empyema, who were non-responsive to chest tube drainage and antibiotic therapy, during February 2014 to September 2018. VATS was performed earlier than the course of medical management time (MMT), 12Â±3 days, thorough previously planned tube thoracostomy incision (5 th intercostal space) in majority of patients as the opening work. Then, the results were compared with possible published related studies at the same stage but in conventional (12-21 days) MMT time. RESULTS: From a total of 62 patients, 52 were males. The age range was 14-80 years. The median postoperative hospital stay was 6 days. The fever and dyspnea reduced after the operation. In majority of the patients, lung was expanded after the VATS but pleural thickening resolved during a follow-up period of 90Â±15 days. No intraoperative complications were observed. Morbidity rates were acceptable. Also, two conversions were performed, and two death cases occurred due to comorbidity. Pleural tissue diagnosis showed no malignancy, tuberculosis in two cases, and the necrotic tissue in remainder. CONCLUSIONS: The single-port VATS in the treatment of fibrinopurulent empyema as a first option is a highly effective approach and has better outcome in during 12Â±3days after MMT. Proper selected initial chest tube incision could be used as the opening work incision in VATS. Â© 2019 EDIZIONI MINERVA MEDICA

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单孔电视胸腔镜手术治疗纤维蛋白脓性脓胸：单一机构的经验

背景:急性胸脓肿需要适当的疾病分期诊断和时间管理。纤维蛋白化脓期脓肿的最佳手术干预时间和治疗方案尚不明确。本研究旨在评估单孔视频胸腔镜手术(VATS)在纤维蛋白化脓性急性胸脓肿治疗中的效果，作为先前胸管切开的第一选择。方法:对2014年2月至2018年9月期间62例对胸管引流和抗生素治疗无反应的纤维蛋白脓性脓肿患者进行横断面前瞻性研究。VATS手术时间早于病程医疗管理时间(MMT)， 12Â±3天，多数患者以事先计划好的管式开胸切口(第5肋间隙)作为开胸工作。然后，将结果与可能发表的在同一阶段但在常规(12-21天)MMT时间的相关研究进行比较。结果:62例患者中，男性52例。年龄范围为14-80岁。术后平均住院时间为6天。术后发热、呼吸困难减轻。大多数患者在VATS后肺扩张，但胸膜增厚在90Â±15天的随访期间消退。无术中并发症。发病率可以接受。此外，进行了两次转换，并发生了两例因合并症而死亡的病例。胸膜组织诊断无恶性肿瘤，2例为结核，其余为坏死组织。结论:单孔VATS作为首选治疗纤维蛋白脓性脓肿是一种非常有效的方法，在MMT术后12Â±3天内疗效较好。选择合适的初始胸管切口可作为VATS的开口处工作切口。Â©2019 edizioni minerva medica

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来源期刊

Minerva Pneumologica RESPIRATORY SYSTEM-

CiteScore

0.90

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0.00%

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期刊介绍： The journal Minerva Pneumologica publishes scientific papers diseases of the respiratory system. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, therapeutical notes, special articles and letters to the Editor. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (www.icmje.org). Articles not conforming to international standards will not be considered for acceptance.