Ätiologie und Behandlung des Pleura-Empyems nach Thoraxeingriffen*

Abstract

Between 1961 and 1974 a total of 29 patients have been treated for empyema after lung resection. Pneumonectomy for bronchus carcinoma had been previously performed in 19 patients, partial resection of the lung in ten. In the majority of cases a technical insufficiency was at last partially responsible for appearance of empyema. Differentiation between empyema after pneumonectomy and empyema in patients with residual lung parenchyma has proved to be of advantage. As to predisposing factors, treatment and prognosis of empyema in cases with residual parenchyma is comparable to regular pulmonary empyema. Empyema after pneumectomy however is different in treatment and prognosis. Irrigation of the infected thoracic cavity either by repeated punction and/or by continous through-drainage is helpful and improves the otherwise poor prognosis.

Instillation of Fibrinolytic Enzymes in the Treatment of Pleural Empyema

“…Durin g reeent yea rs th e ease load of aeut e as weil as of chronie pleural empyema has deereased (4,8) due to early and effeetive antib iotic th erapy . Nevertheless severe eomplieat ions following pneumonia, ehest trauma or thoracie surgery still occur.…”

“…In our opinion this surgieal proeedure sho uld at least be performed afte r 2 or 3 weeks of unsueeessful eonservative therapy 1. • (6,8,10). Instillation of fibrinolytic agents , however, seems to be beneficial in preparing for surgical tre atm ent too because, due to the liquefaction of the empyema , decortication can be performed earlier.…”

“…Pleural empyema is a serious complication following pneumonia, chest trauma or thoracic surgery. The principles of treatment are well defined (4,7,8). Reports on enzymatic clearance of hemat othorax and also empyema date from the days of a high incidence of tuberculosis in the early 1950s.…”

Die thoracoskopische Therapie des Pleuraempyems nach Pneumonektomie

“…Die Entwicklung eines Empyems nach Pneumonektomie ist auch heute noch eine gefürchtete Komplikation und geht mit einer Letalität von bis zu 50 % einher [12]. In über 50 % der Fälle liegt ursächlich eine Bronchusstumpffistel zugrunde [1].…”

“…In der Literatur werden Letalitätsraten bis zu 50 % angegeben [12]. In der Literatur werden Letalitätsraten bis zu 50 % angegeben [12].…”