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Clinical Analysis of Video Assisted Thoracic Surgery for the Treatment of Thoracic Empyema

비디오 흉강경을 이용한 농흉수술의 임상분석

  • Oh, Sang-Gi (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Song, Sang-Yun (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital) ;
  • Yun, Chi-Hyeong (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Na, Kook-Ju (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Kong, Kang-Eun (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital) ;
  • Park, Song-Ran (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital) ;
  • Kim, Sang-Hyung (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital)
  • 오상기 (전남대학교병원 흉부외과) ;
  • 송상윤 (화순전남대학교병원 흉부외과) ;
  • 윤지형 (전남대학교병원 흉부외과) ;
  • 나국주 (전남대학교병원 흉부외과) ;
  • 공강은 (화순전남대학교병원 흉부외과) ;
  • 박송란 (화순전남대학교병원 흉부외과) ;
  • 김상형 (전남대학교병원 흉부외과)
  • Received : 2009.09.27
  • Accepted : 2009.11.11
  • Published : 2010.04.05

Abstract

Background: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. Material and Method: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. Result: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was $90{\pm}38.5\;min$. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chesttube insertion was $11.9{\pm}5.8$ (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. Conclusion: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.

배경: 농흉은 진단법과 항생제의 발달에도 불구하고 흔히 접하게 되는 질환이며, 내원시에 다양한 증상과 형태를 보여 각기 다른 치료법이 적용된다. 최근 흉강경을 이용한 흉부수술이 증가하면서 농흉에 대한 수술 적응증과 방법이 변하고 있어 본 교실에서는 비암성 다발성 흉수와 섬유농성 농흉 및 기질화된 농흉에 대한 비디오 흉강경을 이용한 수술의 임상 분석을 통해 그 유용성을 알아보고자 한다. 대상 및 방법: 2005년 1월부터 2009년 5월까지 암성 질환, 급성혈종, 단순 흉수에 의한 흉막조직 검사를 제외한 다발성 흉수 및 농흉을 주소로 내원한 환자 중 술 전 비수술적 배액법이나 약물치료로 호전이 되지 않아 흉강경 수술을 적용하였던 36명의 환자를 대상으로 술 전 임상 자료와 더불어 수술 방법, 시간, 술후 임상 요소들을 분석하였다. 결과: 수술은 전례에서 흉강경 수술법을 적용하였다. 그 중 1예에서 기술적인 어려움으로 개흉술로 전환하였다. 수술시간은 평균 $90{\pm}38.5$ (30∼200)분 이었고 수술 시에 평가한 American Thoracic Society (ATS) 농흉 단계는 1단계가 1명, 2단계가 24명, 3단계가 11명이었다. 술 후 흉관 거치 기간은 $11.9{\pm}5.8$ (3~24)일이었다. 1명을 제외한 모든 환자에서 호전되었으나 한명은 농흉이 지속되어 재수술을 통해 개방창을 형성하였다. 퇴원시 흉부단순촬영상 늑횡격막각이 소실된 경우가 22예, 흉막 비후 소견이 보이는 경우가 20예, 이 두 가지 모두 보이는 경우가 17예, 두 가지 모두 보이지 않는 경우 11예였으나 추적관찰시에 실시한 흉부단순촬영상 각기 9예, 7예, 4예, 24예로 1예를 제외한 전례에서 호전 소견을 보였다. 결론: 이상의 소견으로 볼 때 다발성 흉수와 농흉에 대하여 비디오 흉강경 수술은 만족할 만한 성적을 보여주었으며 ATS 농흉 단계 1,2단계뿐 아니라 3단계에서도 선택적으로 비디오 흉강경 수술을 적응할 수 있다고 하겠다.

Keywords

References

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  1. Single-port video-assisted thoracoscopic surgery in the management of fibrinopurulent empyema: the experience of a single institution vol.58, pp.1, 2010, https://doi.org/10.23736/s0026-4954.19.01841-8