Der videoassistiert-thoracoskopische Zugang zum Pleuraempyem im Vergleich zu Drainagetherapie oder Thoracotomie

Abstract

Video-assisted thoracoscopic (VAT) debridement is gaining importance in the fibrino-purulent phase of empyema thoracis. However, evaluation of this access compared with mere chest tube drainage or thoracotomy remains unsatisfactory. A total of 356 parapneumonic empyemas from 1986 to 1997 were retrospectively analyzed concerning the results after primary treatment (chest tube 225, thoracotomy 80, VAT 51). The three groups did not differ significantly for gender and associated diseases. Median age of the chest tube drainage group (54 years) was higher than for thoracotomy (43.5 years) or VAT (39 years). Median duration of chest tube treatment after thoracotomy (7 days) was shorter than after VAT (13 days) or chest tube drainage (20 days) (P < 0.0001). The more invasive procedures were also superior to the lesser invasive treatment concerning duration of postoperative hospitalization, recurrence rate and treatment failures. In spite of its better results thoracotomy will be pushed back by VAT in the treatment of empyema thoracis. Acceptance of VAT is reflected in rising numbers of admissions. Based on these retrospective results we are planning a prospective multicenter trial to evaluate the indication for VAT in empyema thoracis.

Erfahrungen in der stadienadaptierten Therapie des Pleuraempyems

“…Gleichzeitig muû ein eventuell bestehender intrapleuraler Totraum zur Rezidivprophylaxe beseitigt werden [33]. Die Therapie des Pleuraempyem gliedert sich in konservative und operative Verfahren (Tabelle 5) [5,11,12,20,25].…”

“…Eine video-thorakoskopische Septendurchtrennung erfolgte bei 6 der nachuntersuchten Patienten. Neuere Studien belegen die Effizienz der minimal-invasiven Chirurgie (videoassistiertthorakoskopisch) auch in spa Èteren Stadien des Pleuraempyems [5,12]…”

Treatment of Post-pneumonic Empyema Thoracis

“…In our series, pneumonococci and staphylococci were found to be the predominant organisms (62.7 %), but no correlation was found between isolates and fatality or decortication as in the ones of Kelly et al [11] and Mandal et al [12]. PET treatment consists of antimicrobial agents [7], daily thoracocentesis and pleural lavage, tube thoracostomy [7], suction drainage, radiologically guided percutaneous catheter insertion [13], intrapleural fibrinolytic debridement using streptokinase or urokinase [14], video-assisted thoracoscopy [15,16], and surgical intervention (rib resection, decortication, thoracoplasty) [2,5,7,17].…”

Computed tomography or ultrasonically guided pigtail catheter drainage in multiloculated pleural empyema: A recommended procedure?

“…Initially, most cases are treated by repeated thoracentesis, image‐guided catheter drainage, 1–5 or closed‐tube thoracostomy. 3,6 Traditional surgical approaches include decortication, 5,7,8 video‐assisted thoracoscopic surgery, 9–11 rib resection and open drainage. 12–15 However, the optimal treatment of empyema depends on its phase of development.…”