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[Therapeutic approach in non-postoperative pleural empyema]
D Divisi1, C Battaglia, R Crisci
1Cattedra di Chirurgia Toracica, Università degli Studi, L'Aquila.
Il Giornale Di Chirurgia
|August 26, 1998
Summary
Video-assisted thoracoscopy (VAT) effectively stages non-surgical thoracic empyema after failed conservative treatment. This approach guides appropriate surgical interventions for better patient outcomes.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Infectious Diseases
Background:
- Non-surgical thoracic empyema presents a significant clinical challenge.
- Conservative management, including intercostal drainage and pleural lavage, has limitations.
Purpose of the Study:
- To evaluate therapeutic procedures for non-surgical thoracic empyema.
- To assess the utility of video-assisted thoracoscopy (VAT) in guiding treatment decisions.
Main Methods:
- Retrospective analysis of 81 patients with non-surgical thoracic empyema.
- Initial treatment involved intercostal drainage and pleural lavage.
- Video-assisted thoracoscopy (VAT) was performed following unsuccessful conservative therapy.
Main Results:
- 56 patients initially received conservative treatment, with 56% failure rate.
- VAT enabled precise staging of infection and guided subsequent interventions.
- Treatments included continued drainage-lavage, transcurrent pleural irrigation, open window thoracostomy with myoplasty, decortication with pleural exeresis, and intrapleural streptokinase.
- Mortality rate was 3.7% (3 deaths).
Conclusions:
- Video-assisted thoracoscopy (VAT) is a valuable tool for staging thoracic empyema.
- VAT facilitates tailored therapeutic strategies after failed conservative management.
- This approach improves the management of complex thoracic empyema cases.