Extrinsic contamination during the operation, spill of infected materials of diseased foci, infection of retained blood or exsudates, and resistance to antibiotics can be numerated main causes of empyema that frequently follows major surgery of the lungs.
The present communication is concerned with the treatment of such empyemas encountered in 2 cases of lobectomy 5 cases of pneumonectomy or pleuro-pneumonectomy for tuberculosis and chlonic empyema.
The empyema following lobectomy was successfully treated by rib resection, and obliteration of the diseased pleural cavity with pediculated subscapularis muscles if necessary.
However, the management of the empyema developing after pneumonectomy or pleuro pneumonectomy differed essentially from that of the foregoing type. We performed open thoracotomy drainage with irrigation in 3 cases and used, in 2 cases. Clagett method of treatment which is characterized by permanent open thoracotomy window followed by closure of the open wound after instillation of neomycin. This method has been felt to be quite satisfactory, and hospital stay of the patients could be shortened.
Relatively fresh chronic empyema with intact lung should primarily be treated by decortication. However, in long standing or recurrent type of empyema especially after middle age, one should be cautious as to the presence of chronic bronchc-pneumonia. bronchietasis, lung abscess and/or bronchopleural fistulas although no evidences of these changes were seen on X-ray films. In 4 cases of the present series with chronic empyema, histologic study revealed these pathologies. Such cases with probable these pathologies should be treated by either pleurolebectomy or pleuropneumonectomy to alleviate the possibility of complications which included lung atelectasis, pleural thickening reinfection and others.
As we were congnizant of effect of the repeated irrigation with antibiotics of pleural cavity, neomycin was applied in 5 cases for irrigation and in 2 cases for seal-in. No untoward effect of the application of neomycin by these methods were experienced.
|