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KMID : 0388420040140010127
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Konkuk Journal of Medical Sciences
2004 Volume.14 No. 1 p.127 ~ p.134
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Video-Assisted Thoracoscopic Surgery for Complicated Parapneumonic Effusion and Empyema
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Kim Yo-Han
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Abstract
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Background: Surgical treatment of complicated parapneumonic effusion (PPE) and empyema is controvertial. Video-assisted thoracoscpic surgery in the treatment of complicated PPE and empyema has been demonstrated but has not been well defined. It has not been determined how to choose patients who can be treated with VATS. We report our experience in the thoracoscopic surgical management of complicated PPE and empyema with review of literatures.
Material and Methods: Between March 1998 and February 2003, 36 patients with complicated PPE and empyema were treated by thoracoscopic surgery. Chest sonography and chest CTscan was performed in all patients before operation. Fibrin clots and fibrinous septation can be detected in early phase of fibrouspurulent stage by chest sonography.
Results: Patients consisted of 30 men and 6 women with a mean age of 58.4 years(range 31~78). General anesthesia was used in 26 patients(all double lumen endotracheal tube) and epidural anesthesia in 10 patients. 4 patients were converted to open decortication because the lung could not be mobilized suffiently to reach both the chest wall and the diaphragm. Mean operation time was 81.2±12 minutes. Chest tube was removed after 7.4±1.2 days. There was 1 hospital motality due to sepsis. All the other patients showed good postoperative courses and simple chest film revealed satisfactory lung re-expansion.
Conclusion: Thoracoscopic surgery for treatment of complicated PPE and empyema shoud be done as early as possible. And chest sonography was useful in deciding the operation time.
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KEYWORD
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Parapneumonic effusion, pleural empyema, thoracoscopic surgery
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