中药治疗脓胸及支气管胸膜瘘

在以往慢性脓胸,尤其是脓胸并发有支气管胸膜瘘,都需要作手术。为薛德氏手术(抽肋骨)及修补瘘口,一般伤口愈合很慢,有时手术后伤口不好,瘘口不愈合,则需反复多次手术,病人长期住院,化费很多钱,遭受很大痛苦,也影响生产。省立一院外科,在响应党的号召,大闹技术革命,学习祖国医学遗产,曾于五八年十一月,用中药治疗脓胸五例,得到良好效果,特介绍以供参考。五例中,一例为腐败性脓胸,病程十六个多月,住院两个月,住院期间曾作胸腔引流,薛德氏手术,修补瘘口两次,换药八个月,残余脓腔仍长达25厘,左右宽5厘,并有支气管瘘。经服中药(肺脓疡丸)一剂,六天完全治愈。一例为支气管扩张,经下叶内、前基底段切除,术后并发脓胸及支气管胸膜瘘,经胸腔引流,伤口愈合很慢,支气管瘘存在。经用大剂量     

胸腔冲洗及引流在肺切除术后支气管胸膜瘘治疗中的应用观察

目的 观察胸腔冲洗及引流治疗肺切除术后支气管胸膜瘘的疗效.方法 6例肺切除术后发生支气管胸膜瘘的患者,根据瘘口直径大小,2例先行胸腔闭式引流,然后在纤维支气管镜下将一直径2 mm导管通过鼻腔经支气管残端瘘口置入胸腔,经导管向胸腔滴注生理盐水;1例采用纤维支气管镜经瘘口注入造影剂,CT下定位残腔并置管引流;3例于锁骨中线第2肋间置管作为冲洗管,于同一腔内低位置管引流.结果治愈4例,死亡2例.结论胸腔冲洗及充分引流治疗支气管胸膜瘘疗效良好.     

慢性结核性脓胸合并支气管胸膜瘘的手术治疗

目的观察外科手术治疗慢性结核性脓胸合并支气管胸膜瘘的疗效。方法慢性结核性脓胸合并支气管胸膜瘘98例,均行胸腔闭式引流术,同时行胸膜剥脱术联合瘘修补术27例、肌瓣填塞术联合局限性胸廓成形术8例、单纯胸廓成形术9例、胸膜肺切除术23例及胸膜剥脱术、瘘修补术联合局限性胸廓成形术13例。结果本组一次手术治愈65例、好转18例,术后1例瘘复发予再次手术治疗,10例发生迁延性肺漏气,4例切口愈合不良。结论外科手术治疗慢性结核性脓胸合并支气管胸膜瘘效果较好。     

电视胸腔镜手术治疗曲霉性脓胸合并支气管胸膜瘘

曲霉性肺炎多属机会性感染，多数情况下是由于患者机体免疫力低下、使用免疫抑制剂或长期使用抗生素导致菌群紊乱所致。严重的侵袭性曲霉性肺炎可造成肺脓肿，继而形成支气管胸膜瘘、曲霉性脓胸，此时全身使用抗真菌药物疗效不佳。文献仅有少数病例报道，但治疗效果并不理想。我院采用电视胸腔镜手术成功治疗1例侵袭性曲霉性肺炎导致的曲霉性脓胸合并支气管胸膜瘘患者，现介绍如下。     

微创管大量冲洗胸腔治疗脓胸

目的观察用内科方法治疗脓胸的效果。方法用套管针胸腔置管闭式引流的方法引流脓液后,用大量抗生素溶液每日冲洗胸腔,治疗顽固性脓胸66例。结果 66例脓胸均脓腔消失,无明显并发症。结论此方法通过内科微创置管治疗脓胸取得良好疗效,避免了胸改术,使患者肺功能,劳动力得到最大的保护,减轻了患者的经济负担。     

带蒂大网膜移植术治疗慢性脓胸和支气管胸膜瘘

1979年11月～1996年12月我们应用脓胸病灶廓清、带蒂大网膜胸腔内移植术治疗58例难治性慢性脓胸,其中合并支气管胸膜瘘(ＢＰＦ)38例,术后近、远期效果良好。对象与方法　58例患者中男41例,女17例,年龄15～58岁。右侧脓胸33例,左侧25例,全脓胸47例。术前病程为0.5～18年,其中38例(66%)合并ＢＰＦ,致病原因见表1。52例曾行胸腔闭式引流术,4例结核性脓胸患者术前3～5年接受过纤维板剥脱、胸廓改形术,1例因开放引流10ｃｍ胶管脱入胸腔形成异物,1例30年前因空洞性肺结核施行了胸膜外塑胶球填充术。36例患者有不同程度的贫血,43例肺功能不全,5例患…     

经纤支镜行气管胸腔内冲洗注药治疗支气管胸膜瘘1例

患者男性,55岁、农民。因高热、右胸痛、咯大量脓痰20天,在当地医院以“肺脓疡”治疗不佳,于1990年4月16日转来我院。体检:体温39.6℃,呼吸26次/分,脉搏120次/分,血压13.3/9.3kPa.消瘦,衰竭,气管向左偏移。右胸廓饱满,语颤减弱,     

胸腔冲洗在结核性支气管胸膜瘘术前治疗中的价值(附68例报告)

回顾性分析2010年1月至2016年12月河北省胸科医院胸外科收治的68例结核性支气管胸膜瘘患者的临床资料。68例患者均给予规律有效的抗结核药物治疗12~18个月,术前均通过胸腔冲洗(根据细菌培养情况给予生理盐水+异烟肼,或生理盐水+左氧氟沙星,或生理盐水+醋酸氯已定)治疗3~12个月,后经单纯胸腔冲洗、胸膜纤维板剥脱术、支气管胸膜瘘修补术、胸廓成形术等方法治疗。结果显示,68例患者经单纯胸腔冲洗瘘口闭合未行手术治疗治愈者7例;行胸膜纤维板剥脱及瘘口修补术治愈20例;行胸廓成形及瘘口修补术治愈38例;长期带管生存3例。对结核性支气管胸膜瘘患者术前应用胸腔冲洗可有效控制胸腔感染,为后期手术创造有利条件。     

结核性脓胸伴支气管胸膜瘘的围手术期护理

回顾总结本院胸外科1998～2002年结核性脓胸伴支气管胸膜瘘64例在外科治疗的同时，加强围手术期护理疗效。本组64例，男38例，女26例，年龄22～66岁；病变位于右侧4JD例左侧24例，本组病例均为肺结核肺叶切除术后，支气管残端瘘所致脓胸。全组病人均接受不同方式的手术：脓腔闭式引流术64例，胸廓成形术46例，其中I期36例Ⅱ期2例在胸改术同时均采用各种方式的胸膜瘘修补术。[第一段]     

甲硝唑胸腔冲洗利福平胸腔注射治疗结核性脓胸疗效观察

目的观察甲硝唑胸腔冲洗联合胸腔注射利福平治疗结核性脓胸的效果。方法收治结核性脓胸病人62例,随机分为两组。均在常规化疗基础上予胸腔闭式引流,治疗组加以甲硝唑脓腔冲洗,利福平注射液脓腔注入治疗;对照组生理盐水脓腔冲洗,利福平注射液脓腔注入治疗。结果治疗组总有效率为93.6%,对照组治疗总有效率为67.7%,两组差异有显著性(P<0.05)。结论甲硝唑冲洗脓腔,结合胸腔注射利福平能彻底清除脓液和坏死组织,增强抗结核分枝杆菌的作用,减轻患者痛苦,疗效显著(P<0.05)。     

Pancreatic pleural effusion accompanied by bronchopleural fistula]

In recent years, chronic massive pleural effusions have been increasingly recognized as a serious complication of pancreatitis. We describe the third reported case of a pancreatic pleural effusion accompanied by bronchopleural fistula. A 49-year-old man suffering from chronic alcohol-related pancreatitis was admitted to our hospital complaining of cough and shortness of breath. A chest x-ray film disclosed a large right pleural effusion with an air-fluid level. Ultrasonography and computed tomography of the upper abdomen demonstrated a giant pancreatic pseudocyst in the pancreatic tail and a fistulous tract reaching into the posterior mediastinum via the esophageal hiatus. Thoracentesis revealed sterile hemorrhagic fluid with markedly elevated amylase activity of 20,955 IU/l (pancreatic isozyme, 100%) and no malignant cells. A diagnosis of pancreatic pleural effusion was made. The therapy for pancreatic internal fistula is somewhat controversial. We employed conservative therapy, including hyperalimentation and chest tube drainage that successfully decreased the pleural effusion and closed the fistulous tract. Nonetheless, we were still troubled by a continuous air-leak via the drainage tube. Pleurodesis confirmed the tentative diagnosis of bronchopleural fistula and successfully stopped the air-leak. No re-accumulation of pleural effusion has been seen for 2 years. We concluded that pancreatic enzyme-rich effusions, if long-standing, may be complicated by bronchopleural fistula, thus underscoring the need for urgent drainage and initially conservative management.     

Chronic tuberculous empyema with bronchopleural fistula resulting in treatment failure and progressive drug resistance

We treated five patients with a past history of tuberculous pleural infection that led to chronic, quiescent, loculated empyema. Reactivation of TB was associated with formation of BPF and recovery of drug-susceptible Mycobacterium tuberculosis from sputum. All patients had recurrence of positive sputum cultures that yielded tubercle bacilli resistant to drugs they were receiving. The lungs demonstrated gross thickening with calcification of both visceral and parietal pleura. Two patients underwent retreatment chemotherapy followed by decortication-empyemectomy and lung resection surgery; both are now culture-negative for TB. One patient received retreatment chemotherapy but refused surgery; he remains clinically stable with negative sputum cultures. Two other patients' organisms became drug-resistant and they remain sputum-culture positive. We believe that thick, calcified pleural walls limit penetration of drugs into the infected empyema space, resulting in suboptimal drug concentrations and drug resistance. Intensified chemotherapy and surgical intervention should be considered in these cases.     

A case of Aspergillus empyema with bronchopleural fistula

Pleural aspergillosis is not a common disease and we recently experienced a case of Aspergillus empyema with bronchopleural fistula. A 76 year-old man was admitted to our hospital with productive cough and fever. Chest X-ray films showed infiltration in the right lower and left middle field and rather lucent area (clearing) in the right lower lung. Antibiotic therapy was administered but no improvement was obtained. Chest CT scan and right bronchography revealed empyema in the right back portion and bronchopleural fistula in the right lower lobe. Needle aspiration biopsy was performed and Aspergillus fumigatus was isolated from pus. A diagnosis of Aspergillus empyema with bronchopleural fistula was made. We began intrapleural administration of miconazole and empyema was improved partially. For the complete treatment, right lower lobectomy and decortication were performed, but unfortunately he died of acute pneumonia 16 days after operation.     

The performance of four pleural drainage systems in an animal model of bronchopleural fistula

In order to compare the performance of four pleural drainage units (PDU [Emerson Post-Operative Pump, Pleur-Evac, Sentinel Seal, Thora-Klex]), we created an animal model of bronchopleural fistula that simulated the type of air leak seen clinically (mean maximal flow = 5 L/min). The PDU were tested at 0 cm (water seal), -20 cm and -40 cmH2O suction. Compared to water seal, -20 cmH2O suction significantly increased the ability of all four PDU to evacuate air via the chest tube and abolished small differences in chest tube air leak seen among the PDU at water seal. An increase in suction to -40 cmH2O did not significantly alter flow via the chest tube. Previously demonstrated differences among the PDU in handling large air flows were not seen in this lower flow model of bronchopleural fistula. However, because of their higher resistance, use of the Sentinel Seal and of the Thora-Klex was technically impractical even at air leaks of 4 to 5 L/min.     

Successful treatment of pleural aspergillosis and bronchopleural fistula.

We report the successful treatment of a patient with a bronchopleural fistual and pleural aspergilloma. Treatment consisted of intrapleural instillation of amphotericin B and nystatin followed by creation of an Eloesser flap.     

Irrigation drainage and fibrinolysis for treatment of parapneumonial pleural empyema

We report on our experiences on 336 patients suffering from manifest pleural empyema within a period of 10 years (1985-1995). Considering the pathogenesis, particularly the results of 218 patients with "parapneumonic pleural empyema" were analysed retrospectively. Definite healing could be achieved by chest tube placement and pleural irrigation in 201 patients (= 92.2%). Other 11 patients finally needed surgical interventions (= 5%). Only 6 patients could not be cured: An indwelling tube was palliatively inserted once and 5 patients died in the course of the medical treatment (mortality = 2.3%). Within the first years the irrigation therapy was performed using a single chest tube (n = 38%) but since 1989 a double-lumen drainage was used (n = 158). Since 1987 in most cases (n = 182) intrapleural medicinal fibrinolysis was performed by instillation of streptokinase (Varidase N). If outward invasively pretreated patients (n = 30) are analysed separately, a statistical dependency can be found between the duration and the way of treatment. Without significant difference between the groups (Gr) the average duration of treatment using a single tube without fibrinolysis (Gr1) was 31.8 days, but 26.5 days using a single tube combined with fibrinolysis (Gr2). A clear shortening of the duration is detectable if patients were treated with a combination of double lumen drainage and fibrinolysis: If 2 tubes were used (Gr4) the treatment lasted 20.6 days, using one double-lumen tube (Gr5) it took 19.8 days. There is a proof of significance at comparison of Gr4 with Gr1 (p = 0.005). Gr5 with Gr1 (p < 0.001) and Gr5 with Gr2 (p = 0.014) respectively. A significant longer duration of treatment (40.6 days, p < 0.001) is found for the group of the pretreated patients, if compared with the corresponding groups Gr4 or Gr5. CONCLUSION: Parapneumonic empyemas most often can be cured by irrigation drainage. The mortality is comparatively low. The shortest duration of treatment is needed using the combination of a double-lumen tube with intrapleural instillation of a fibrinolytic agent (Varidase N). Invasively pretreated patients need significantly longer durations at same form of treatment.