慢性肺水肿急性加重期的成功治疗:病例报告。

Junichi Morimoto, Taiki Fujiwara, Ryo Karita, Jotaro Yusa, Mitsutoshi Shiba, Tomohiko Iida
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引用次数: 0

摘要

背景:慢性肺水肿大多由急性胸腔积液或结核性胸膜炎引起。开胸手术和剥离术是治疗慢性肺水肿的传统方法。然而,有些病例,如大腔周围有较厚钙化的病例,可能很难在一次手术中完成剥离。我们成功治疗了一例慢性肺水肿病例,患者胸腔内有一个巨大的空腔,空腔周围有一层厚厚的钙化膜,通过负压伤口疗法(NPWT)进行胸腔穿刺,每天逐渐剥离钙化膜:患者是一名 47 岁的男性,10 年前曾在另一家医院因肺炎后左肺水肿接受过胸腔引流术。他因发烧 39 摄氏度、痰中带血、严重乏力 3 天来我院就诊。计算机断层扫描显示,左肺叶内间隙有一个 9 厘米的肿块阴影,邻近有一个 21 × 15 × 9 厘米的充满液体的钙化单眼空腔,厚度达 5 毫米。他接受了胸腔积液引流术,并怀疑出现了肺水肿;积液呈恶臭脓性。患者接受抗生素和胸腔内灌洗后病情未见好转,因此进行了胸腔镜剥离术。胸腔内有一层厚厚的钙化膜,里面充满了类似陈旧血液的暗红色浆液。我们尝试进行剥离,但钙化膜难以清除。我们使用了两个引流管进行胸腔灌洗。然而,胸腔内灌洗和引流未见好转,因此我们进行了穿刺。每天剥离钙化膜,持续了 3 个月。肉芽逐渐增多,炎症反应也有所改善。经过 NPWT 治疗,空腔逐渐缩小至 8 厘米 × 6 厘米 × 2 厘米。进行了背阔肌皮瓣闭合术,患者痊愈出院:这是一份关于使用 NPWT 对慢性肺水肿患者的高度钙化化脓膜进行日常剥离的内容丰富的报告。对该方法的描述将有助于慢性肺水肿和厚钙化膜患者的治疗。
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Successful treatment with fenestration followed by daily decortication and negative-pressure wound therapy for acute exacerbation of chronic empyema: a case report.

Background: Most cases of chronic empyema are caused by acute thoracic empyema or tuberculous pleuritis. Open thoracotomy and decortication are traditional treatments for chronic empyema. However, some cases, such as those with thick calcifications around a large cavity, may be difficult to decorticate in a single surgery. We successfully treated a case of chronic empyema with a large cavity surrounded by a thick calcified membrane that was peeled off gradually each day through fenestration of the thoracic cavity with negative-pressure wound therapy (NPWT).

Case presentation: The patient was a 47-year-old man who had undergone thoracic drainage for left post-pneumonia empyema at another hospital 10 years previously. He presented to our hospital with a fever of 39 °C, bloody sputum, and severe fatigue for 3 days. Computed tomography showed a 9-cm mass shadow in the left intralobar space and an adjacent 21 × 15 × 9-cm fluid-filled calcified unilocular cavity up to 5 mm in thickness. He underwent thoracic drainage for fluid, and empyema was suspected; the fluid was foul-smelling and purulent. The patient did not improve with antibiotics and intrathoracic lavage; therefore, thoracoscopic decortication was performed. The thoracic cavity had a thick calcified membrane filled with dark-red slurry resembling old blood. We attempted decortication; however, the calcified membrane was difficult to remove. Two drains were used for the pleural lavage. However, no improvement was observed with intrathoracic lavage and drainage; therefore, a fenestration was performed. The calcified membrane was peeled off each day for 3 months. Gradually, granulation increased and the inflammatory reaction improved. After NPWT, the empyema cavity gradually shrank to 8 cm × 6 cm × 2 cm. A latissimus dorsi flap closure was performed, and the patient was discharged.

Conclusions: This is an informative report on the daily decortication of a highly calcified purulent membrane using NPWT in a patient with chronic empyema. The description of this method will aid in the management of patients with chronic empyema and thick calcified membranes.

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