Tailored thoracomyoplasty as a valid treatment option for chronic postlobectomy empyema.

Détails

ID Serval
serval:BIB_D94FE6D3319C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Tailored thoracomyoplasty as a valid treatment option for chronic postlobectomy empyema.
Périodique
Annals of Thoracic Surgery
Auteur(s)
Fournier I., Krueger T., Wang Y., Meyer A., Ris H.B., Gonzalez M.
ISSN
1552-6259 (Electronic)
ISSN-L
0003-4975
Statut éditorial
Publié
Date de publication
2012
Volume
94
Numéro
2
Pages
387-393
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
BACKGROUND: Chronic post-lobectomy empyema is rare but may require space obliteration for infection control. We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection control and functional outcome.
METHODS: We retrospectively analyzed 17 patients (11 men, 6 women) with chronic postlobectomy empyema who were treated by thoracomyoplasty in our institution between 2000 and 2011. All patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n = 6). In 5 patients, bronchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior-rhomboid myoplasty, which also served to close a bronchopleural fistula, if present. The first rib was resected in 11 of 17 patients.
RESULTS: The 90-day mortality was 11.7%. Thoracomyoplasty was successful in all surviving patients with respect to infection control, space obliteration, and definitive closure of bronchopleural fistula, irrespective of the type of infection, the presence of a bronchopleural fistula, or whether a first rib resection was performed. Postlobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEV(1) of 63.0% ± 8.5% and 51.5% ± 4.2% (p = 0.01) and a mean predicted DLCO of 59.8% ± 11.6% and 54.5% ± 12.5%, respectively. Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy.
CONCLUSIONS: Tailored thoracomyoplasty represents a valid option for patients with chronic postlobectomy empyema without requiring a preceding open window thoracostomy. Space obliteration and infection control were equally obtained with and without first rib resection.
Pubmed
Web of science
Open Access
Oui
Création de la notice
27/08/2012 17:19
Dernière modification de la notice
20/08/2019 15:58
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