临床小儿外科杂志
臨床小兒外科雜誌
림상소인외과잡지
JOURNAL OF CLINICAL FEDIATRIC SURGERY
2014年
3期
211-213
,共3页
王贤书%程征海%杨志国%张晓茹%景世元%曹红宾%李鑫%岳芳%方江顺%陈志国%高飞飞%刘叶
王賢書%程徵海%楊誌國%張曉茹%景世元%曹紅賓%李鑫%嶽芳%方江順%陳誌國%高飛飛%劉葉
왕현서%정정해%양지국%장효여%경세원%조홍빈%리흠%악방%방강순%진지국%고비비%류협
积脓,胸腔%外科手术%儿童
積膿,胸腔%外科手術%兒童
적농,흉강%외과수술%인동
Empyema,Pleural%Surgical Procedures,Operative%Child
目的：探讨小儿脓胸的流行病学特征、诊治方法和手术时机。方法回顾性分析2000年1月至2013年1月我们收治的402例小儿脓胸患儿临床资料。年龄1个月至13岁，其中1～3岁202例。急性脓胸183例，慢性脓胸219例。310例行血培养，305例行胸水培养。374例入院后行胸腔穿刺，312例进一步行胸腔闭式引流术，4例行脓腔开放引流。57例局限性肺不张或肺实变行纤维支气管镜检查肺泡灌洗术1～3次。298例在常规治疗4周后行胸膜纤维板剥脱术。结果血培养22例肺炎链球菌阳性，18例葡萄球菌阳性；胸水培养20例肺炎链球菌阳性，18例葡萄球菌阳性。行纤维支气管镜检查肺泡灌洗术者43例治愈。无死亡病例。402例均痊愈出院，出院后1、3、6、12个月随访，均恢复良好。结论病原学检查为脓胸的早期诊断和治疗提供了帮助；尽早选择有效的方法，充分引流脓液是提高治愈率的关键；手术治疗要选好时机，在微创及肺保护的理念下采取合理措施。
目的：探討小兒膿胸的流行病學特徵、診治方法和手術時機。方法迴顧性分析2000年1月至2013年1月我們收治的402例小兒膿胸患兒臨床資料。年齡1箇月至13歲，其中1～3歲202例。急性膿胸183例，慢性膿胸219例。310例行血培養，305例行胸水培養。374例入院後行胸腔穿刺，312例進一步行胸腔閉式引流術，4例行膿腔開放引流。57例跼限性肺不張或肺實變行纖維支氣管鏡檢查肺泡灌洗術1～3次。298例在常規治療4週後行胸膜纖維闆剝脫術。結果血培養22例肺炎鏈毬菌暘性，18例葡萄毬菌暘性；胸水培養20例肺炎鏈毬菌暘性，18例葡萄毬菌暘性。行纖維支氣管鏡檢查肺泡灌洗術者43例治愈。無死亡病例。402例均痊愈齣院，齣院後1、3、6、12箇月隨訪，均恢複良好。結論病原學檢查為膿胸的早期診斷和治療提供瞭幫助；儘早選擇有效的方法，充分引流膿液是提高治愈率的關鍵；手術治療要選好時機，在微創及肺保護的理唸下採取閤理措施。
목적：탐토소인농흉적류행병학특정、진치방법화수술시궤。방법회고성분석2000년1월지2013년1월아문수치적402례소인농흉환인림상자료。년령1개월지13세，기중1～3세202례。급성농흉183례，만성농흉219례。310례행혈배양，305례행흉수배양。374례입원후행흉강천자，312례진일보행흉강폐식인류술，4례행농강개방인류。57례국한성폐불장혹폐실변행섬유지기관경검사폐포관세술1～3차。298례재상규치료4주후행흉막섬유판박탈술。결과혈배양22례폐염련구균양성，18례포도구균양성；흉수배양20례폐염련구균양성，18례포도구균양성。행섬유지기관경검사폐포관세술자43례치유。무사망병례。402례균전유출원，출원후1、3、6、12개월수방，균회복량호。결론병원학검사위농흉적조기진단화치료제공료방조；진조선택유효적방법，충분인류농액시제고치유솔적관건；수술치료요선호시궤，재미창급폐보호적이념하채취합리조시。
Objetive To investigate the epidemiological features,diagnosis and treatment,and the suit-able time for surgical management of pediatric empyema. Methods The clinical data of 402 cases with pediat-ric empyema from January 2000 to January 2013 were retrospectively analyzed.The age range was 1 month to 13 years including 202 cases in the range of 1 year to 3 years.There were 183 acute empyema and 219 chronic em-pyema,310 hemoculture,305 pleural fluid culture,374 cases under thoracentesis,312 cases under pleural cavity closed drainage and 4 cases under pleural cavity opened drainage.Bronchofibroscope inspection and pulmonary alveoli cleaning were used in 57cases.298 cases were under fibrous lamina denudation after 4 weeks routine treatment. Results 22 Streptococcus pneumoniae positive cases and 18 staphylococci positive cases were in the hemoculture.20 Streptococcus pneumoniae positive cases and 18 staphylococci positive cases were in the pleural fluid culture.43 cases were cured under the ronchofibroscope inspection and pulmonary alveoli clean-ing.There was no death.All the 402 cases got fine results to leave hospital and 1,3,6,and 12 months follow-up. Conclusions Etiologic analysis was helpful for the early diagnosis and treatment of pediatric empyema. The key point for the cure rate improvement was sufficient drainage of pus with an effective method in the early stage.The surgical management should be in the suitable time and under the principle of minimally invasive and lung protection.
