Empiema pleural en 343 casos con tratamiento quirúrgico: características, resultados inmediatos y factores asociados a morbilidad y mortalidad

Abstract

Pleural empyema. Retrospective review of 343 patientsBackground: Pleural empyema still has a dismal prognosis. Aim: To describe features and prognostic factors of patients with pleural empyema subjected to surgical procedures. Material and Methods: Retrospective review of 343 patients with pleural empyema (mean age 52 years, 71% males), that were subjected to any type of surgical procedure. Criteria for diagnosis of empyema were a positive culture, a fluid pH of less than 7.2 or a compatible macroscopic appearance of the fluid. Results: Empyema was secondary to pneumonia in 243 patients (71%), secondary to surgical procedures in 41 patients (12%), secondary to trauma in 19 patients (5.5%), secondary to a lung abscess in 10 patients (3%), tuberculous in 10 patients (3%), neoplastic in two cases (0.6%), secondary to pneumothorax in 2 cases (0.6%) and of unknown origin in 13 patients (4%). A microorganism was isolated from pleural fluid in 89 patients (26%). The surgical procedures performed were 251 decortications by thoracotomy (73%), 70 pleurotomies (20%), 11 video assisted surgeries (3%), seven decortications with lung resections and four fenestrations. Complications were recorded in 104 patients (30%), 29 patients were re-operated (8.5%) and 31 died (10%), all due to sepsis. Conclusions: The main cause of pleural empyema is pneumonia. In most patients, microorganisms are not isolated from pleural fluid, thoracotomy with decortication is the most frequent surgical procedure. There is a high rate of complications and mortality.

Neumotórax espontáneo y enfisema bulloso bilateral

“…En casos de neumotórax recurrente o persistente, cuando el pulmón permanece sin expandir a pesar del correcto funcionamiento del drenaje torácico, el tratamiento más aceptado es el quirúrgico. Mediante videotoracoscopia y con endograpadoras, se resecan las ampollas subpleurales y, posteriormente, se procede a la abrasión pleural y la pleurodesis química para lograr la sínfisis pleural 3,18 . Las posibilidades de recidiva durante el primer episodio son mayores en los pacientes con neumotórax secundario a enfermedad pulmonar obstructiva crónica, pero las recurrencias se reducen al 25 % con la pleurodesis.…”

“…Los procedimientos mínimamente invasivos, como la cirugía videotoracoscópica o video-asistida, son la vía de abordaje más utilizada en los empiemas pleurales cuando se diagnostican por primera vez. En este paciente, se resolvió con la pleurotomía, procedimiento que se considera de elección para el empiema pleural en sus fases iniciales, cuando existen enfermedades asociadas que contraindiquen la cirugía y cuando la expectativa de vida es limitada 18 .…”

Complicaciones y tratamiento de herida hepática por proyectil de arma de fuego. Un enfoque retrospectivo

“…Empyema is defined as the presence of pus in the pleural space. This occurs after surgery as a complication of diverse traumatic events 27 , most of the time due to the presence of Streptococcus pneumoniae 28 . In addition to this complication, our patients presented, together with LT, thoracic involvement, which required surgical intervention.…”