Objective: The efficacy of video-assisted thoracoscopic surgery (VATS) in patients with acute empyema has been reported over the last several decades. The American Association for Thoracic Surgery (AATS) consensus guideline recommends VATS as the first-line treatment for all patients with stage-II acute empyema. The objective of this study was to evaluate the efficacy of VATS in patients with acute empyema in our hospital.
Methods: From January 2003 to May 2017, 28 patients underwent the complete evacuation of potentially infected fluid and/or material, and they showed complete re-expansion of the lungs. We retrospectively analyzed the medical records and extracted information on clinical features, preoperative treatment, operation-related factors, and the outcome of each patient.
Results: Of these 28 patients, 79% (n=22) were men, and the mean age was 67.3 years (31-80 years). The stages of empyema based on the ATS classification were I in 7% (n=2), II in 82% (n=23), and III in 11% (n=3). Preoperative cultures of pleural effusion were positive in 39% (n=11) of patients. VATS was chosen in all cases, and there was no conversion to open thoracotomy in any case. Postoperative complications occurred in 7% (n=2) of patients; gastric perforation, 1; and interstitial pneumonia, 1. The median durations of pre- and postoperative stays were 8 (range, 0-36) and 11 (range, 6-153) days, respectively.
Conclusions: VATS in patients with acute pleural empyema was safe, and it reduced the length of stay, blood loss, and postoperative complications (including 30-day mortality). The therapeutic effect of VATS was very favorable in patients with stage-II empyema, and VATS may be indicated in some patients with stage-III empyema.
"},{"@language":"ja","@value":"近年，急性膿胸に対する胸腔鏡下膿胸腔掻爬術の有用性についての報告が増加してきている．2017年の米国胸部外科学会コンセンサスガイドラインでは，Class IIAの推奨度でII期急性膿胸に対する一次治療として胸腔鏡下手術を行うべきとされた．2003年1月から2017年5月までに当院で治療を受けた患者28人を対象とした．男性22人，女性6人，年齢31-80歳（平均67.3歳）．術前待機期間は0-36日（中央値8日），術前胸水培養は11例で陽性であった．術前病期分類は，I期2人，II期23人，III期3人であった．術後合併症は1例で胃穿孔，1例で肺野の間質影が出現した．術後膿胸再燃は2例で認めた．手術関連死亡例および開胸移行例を認めず，術後在院日数は6-153日（中央値11日）であった．急性膿胸に対する胸腔鏡下膿胸腔掻爬術は安全かつ低侵襲な術式であり，II期だけではなくIII期膿胸症例にも有効な可能性がある．
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Surgery"},{"@language":"ja","@value":"日本呼吸器外科学会"}],"prism:publicationDate":"2018","prism:volume":"32","prism:number":"2","prism:startingPage":"130","prism:endingPage":"135"},"reviewed":"false","dcterms:accessRights":"http://purl.org/coar/access_right/c_abf2","url":[{"@id":"https://www.jstage.jst.go.jp/article/jacsurg/32/2/32_130/_pdf"},{"@id":"https://search.jamas.or.jp/link/ui/2018172829"}],"availableAt":"2018","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E6%80%A5%E6%80%A7%E8%86%BF%E8%83%B8","dc:title":"急性膿胸"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%83%B8%E8%85%94%E9%8F%A1%E4%B8%8B%E8%86%BF%E8%83%B8%E8%85%94%E6%8E%BB%E7%88%AC%E8%A1%93","dc:title":"胸腔鏡下膿胸腔掻爬術"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%86%BF%E8%83%B8%E6%B2%BB%E7%99%82%E3%82%AC%E3%82%A4%E3%83%89%E3%83%A9%E3%82%A4%E3%83%B3","dc:title":"膿胸治療ガイドライン"},{"@id":"https://cir.nii.ac.jp/all?q=%E7%B1%B3%E5%9B%BD%E8%83%B8%E9%83%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A","dc:title":"米国胸部外科学会"},{"@id":"https://cir.nii.ac.jp/all?q=acute%20empyema","dc:title":"acute 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