ORIGINAL ARTICLES   

Minerva Chirurgica 2006 April;61(2):103-12

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

Pleural Empyema: Considerations about Experience of the Thoracic Surgery Division in Monza and Proposal of Therapeutic Protocol

Sciuchetti J. F., Corti F., Ballabio D.

¹ Divisione di Chirurgia Toracica Dipartimento di Chirurgia Cardiotoracica A. O. San Gerardo, Monza 2 Divisione di Cardiochirurgia Dipartimento di Chirurgia Cardiaca e Toracica A. O. San Gerardo, Monza

im. Optima l treatment of thoracic empyema depends on its phase of development. Thin, free-flowing exudative effusions can be adeguately managed by thoracenthesis or simple closed tube thoracostomy and antibiotics. At the other end of the spectrum are well-organized chronic empyemas which are best treated with thoracothomy and decortication. In-between this two extremes are fibrino-purulent empyemas for which much controversies exist among pneumologists and thoracic surgeons over the most effective treatment. The authors present their experience about treatment of pleural empyema.
Methods. This retrospective study reviewes the Thoracic Surgery Department of Monza’s S. Gerardo Hospital experience between 1982-2004 in the treatment of thoracic empyema and tries to formulate our own guidelines for the management of the fibrino-purulent forms.
Results. In our experience we used a personal tecnique of thoracic drainage consisting in continuous wash-out of pleural cavity associated with intrapleural fibrinolytic if is it necessary. Since 1994 we have used the continuous positive alveolar pressure to mend lungs espansion and improve the results.
Conclusion. Recent reports in the medical and surgical literature have suggested that empyemas can be managed effectively with less aggressive treatment than has been advocated in the past. In spite of the recent development of mini-invasive surgical techniques for the treatment of fibrino-purulent empyemas we believe that first approach should be always conservative. Intrapleural fibrinolytics seem to get improve the efficacy of closed tube thoracostomy.