Empyema and surgical managmenet.

What is empyema

Empyema, refers to pus in the pleural cavity. The pleural cavity is a potential cavity located between the chest wall and the lungs. Its function is to create negative pressure to assist the lungs in breathing and maintain the balance of the pleural fluid. Under normal physiology, the lungs are attached to the chest wall. If there is any abnormality, the pleural cavity will show its space. If the trauma causes hemostasis of the pleural cavity, it is hemothorax; alveolar rupture, and the accumulation of air in the pleural cavity, it is pneumothorax.

Common symptoms

Clinical symptoms of empyema patients include fever, chest pain, sputum cough, and white blood cell hyperplasia on blood tests. The course of empyema can generally range from effusion in the acute phase to empyema in the subacute phase, and finally progress to chronic empyema causing fibrosis. The chest X-ray shows the phenomenon of effusion, and then the pleural fluid is sucked through the puncture needle through the chest wall. From its appearance, plus a series of biochemical tests, pH measurement, Gram stain, and bacterial culture, in addition to confirming the diagnosis and take correct and effective treatment. Due to personal physical differences, different resistances, different underlying diseases, and different pathogenic bacteria, each clinician will master the following basic principles when treating empyema patients: determine the underlying cause of empyema, and perform bacterial culture of pus. And choose the correct and effective antibiotics, improve the nutritional status of patients, supply body fluids, and correct anemia.

 Indications for surgery Examination of pleural fluid, if there are signs of inflammation, should be treated as empyema, you can first take a chest tube to drain pleural cavity empyema, acute or subacute stage, about 80% of patients, can Intubation treatment, if the drainage treatment is not ideal or the course of the disease enters the chronic phase, we must consider open thoracic surgery. Due to the inflammation of the thoracic cavity, it will cause thickening of the pleura, fibrous hyperplasia will form multiple cavity pus, and when it enters the chronic phase, it will even compress the normal lung tissue, causing the lungs to collapse and affecting respiratory function. It can be seen that the more it gets into the chronic phase, the more difficult it becomes to handle. The purpose of thoracotomy is to remove the thickened pleural tissue, so it is called "skinning", which completely removes the pus in multiple cavities to achieve the purpose of expansion surgery. It is also expected that the collapsed lungs can be re-expanded. To improve respiratory function. If the skin peeling fails to do its best, the lungs will collapse for too long and the swelling will be poor, which will cause the existence of cavities. If not treated, pus will be repeatedly accumulated and cannot be cured. At this time, the muscles outside the chest wall must be considered to transfer to pleural cavity to fill the cavity; or, multiple bones are removed to collapse the chest wall to eliminate the cavity. In short, there are many ways to clear the pus, remove the thickening help film, and avoid the cavity to achieve the purpose of surgery.

Surgical approach

Standard thoracotomy: At the fifth intercostal position, a lateral wound of about 20-25 cm enters the chest cavity, which is a surgical method for empyema with severe adhesions.

Mini-thoracotomy: In the fourth or fifth intercostal position, a lateral wound of about 10-15 cm enters the chest cavity to facilitate the removal of purulent tissue fluid.

Thoracoscopy and Video-Assisted Thoracic Surgery (VATS), patients undergo surgery under minor wounds, shortening the treatment period, reducing pain, and quickly recovering to work.

Surgical complications

Possible complications, side effects or risk: The probability of complications is about: 15% -30%, possible sequelae and complications: (a) anaphylactic shock caused by anesthesia (b) surgical bleeding (c) wounds Infections (d) pneumonia (e) stroke (f) cardiovascular infarction (g) sepsis (h) respiratory failure.

Conclusion

Due to personal physical differences, different resistances, different underlying diseases, and different pathogenic bacteria, each clinician will master the following basic principles when treating empyema patients: determine the underlying cause of empyema, and do bacterial culture of pus. And choose the correct and effective antibiotics, improve the nutritional status of patients, supply body fluids, and correct anemia. The medical literature reports about ten percent, and even reports 40 percent mortality. Even if the chest tube drainage treatment is cured, it must be admitted for at least two weeks. Early diagnosis and early treatment are still the unbreakable rule of dealing with empyema. If you have a fever, a constant cough, or even chest pain, seek medical attention to avoid delays in treatment.