小儿脓胸402例临床分析  

Clinical analysis of pediatric empyema： 402 cases report

作　　者：王贤书[1] 程征海[1] 杨志国[1] 张晓茹[1] 景世元[1] 曹红宾[1] 李鑫[1] 岳芳[1] 方江顺[1] 陈志国[1] 高飞飞[1] 刘叶[1] 

机构地区：[1]河北省儿童医院胸外科,河北省石家庄市050031

出　　处：《临床小儿外科杂志》2014年第3期211-213,共3页Journal of Clinical Pediatric Surgery

基　　金：基金项目：河北省医学适用技术跟踪项目（GL2012012）

摘　　要：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。Objetive To investigate the epidemiological features, diagnosis and treatment, and the suitable time for surgical management of pediatric empyema. Methods The clinical data of 402 cases with pediatric 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 empyema ,310 hemocuhure,305 pleural fluid culture, 374 cases under thoracentesis,312 cases under pleural cavity closed drainage and 4 cases under pleural cavity opened drainage. Bronchofibroscope in^peetion and pulmonary alveoli cleaning were used in 57cases. 298 cases were under fibrous lamina denudation after 4 weeks routine treatment. Results 22 Streptococeus pneumoniae positive cases and 18 staphylococci positive eases were in the hemocuhure. 20 Streptococcus pneumoniae positive cases and 18 staphylococci positive eases were in the pleural fluid culture. 43 cases were cured under the ronehofibroscope inspection and pulmonary alveoli cleaning. There was no death. All the 402 cases got fine results to leave hospital and 1,3,6 ,and 12 months followup. 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.

关 键 词：积脓 胸腔 外科手术 儿童 

分 类 号：R726.55[医药卫生—儿科]