いわゆるSilent Empyemaの治療方針について

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Although the lung surgery has been safely performed recently, the radical operation for empyema thoracis is still difficult and its results are not always satisfactorily. In these circumstances, even in surgeons, the radical operation does not urge for the patients with quiescent empyema which has not any, symptoms and the patients without symptoms are kept under observation. Since 1967, at the Chest Disease Research Institute Hospital of Kyoto University, one hundred and forty cases of empyema were treated. In this series it is included 8 cases with acute empyema, 57 cases with post-operative empyema and 75 with chronic one which had so-called silent phase of the empyema, namely some quiescent periods over three months. Seventy-three out of 75 cases with silent phase were, operated and reviewed as the object of this series. CAUSES of EMPYEMA; In sixty-eight patients out of 75, an underlying lessions can be estimated; 34 cases (50%) are pleurisy. 18 cases (26%) following artificial pneumothorax. Three quarters of the chronic empyema are presumed to be tuberculous. INTERVALS of SILENT PHASE; More than half of these cases have been 4, uiescent during ten years or more and one of them has been asymptomatic for 40 years. SYMPTOMS; Except 27 cases without symptoms, symptoms such as hemoptysis (15 cases), formation of bronchopleural or cutaneous fistulae (9), swelling of the chest wail (4), etc., are developed in 48 cases. Only three cases develope some signs of acute inflammation. Empyema with fistulae is found frequently in patients with pleural calcification OPERATIVE METHODS and their RESULTS; Seventy three patients are operated. Resection which included decortication combined with lobectorny is performed on 26 cases. Decortication is done on 27 cases and empyema-space reducing procedures such as thoracoplasty is employed on 5 cases. Another 15 cases are treated with preliminary open treatment and thereafter radical operation is done. In the cases without symptoms (so called silent empyema), the excellent operative results are obtained. Postoperative death among these 27 cases is only one case who died because of pneumonia due to agranulocytosis at 18 months later. Death rate in cases with symptoms is as high as in the postoperative empyema. (Operative mortality rate is 12% and 14%, respectively.) HISTOLOGICAL FINDINGS; On the microscopic examination of the pleura, interstitial tissue layer of the visceral pleura is well preserved in the cases in which decortication is easily performed; while in those patients in whom such procedure is difficult, usually all vestiges of the mesotherial layer are lost, and the fibrotic process extends into the substance of the pleura and even into the lung. Even in the clinically quiescent cases, infiltration with leucocytes and giant cells is observed in the lung parenchyma.
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いわゆるSilent Empyemaの治療方針について

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