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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546

Rev. Col. Bras. Cir. vol.27 no.1 Rio de Janeiro Jan./Feb. 2000

http://dx.doi.org/10.1590/S0100-69912000000100009 

ARTIGOS ORIGINAIS

 

Decorticação pleural precoce no tratamento do empiema pleural complicado na criança

 

Early decortication in the management of complicated empyema in children

 

 

Carlos Eduardo Prieto Velhote, TCBC-SPI; Manoel Carlos Prieto Velhote, ACBC-SPII; Tais Franco de Oliveira VelhoteIII

IEspecialista em Cirurgia Pediátrica CIPE/AMB, Cirurgião Pediátrico do Hospital Carlos Chagas
IIProfessor Assitente Doutor da Disciplina de Cirurgia Pediátrica do Instituto da Criança do Hospital das Clínicas da FMUSP. Cirurgião Pediátrico do Hospital Carlos Chagas
IIICirurgiã Pediátrica do Hospital Carlos Chagas

Endereço para correspondência

 

 


RESUMO

Os autores avaliam dez casos de empiema pleural tratados inicialmente pela drenagem pleural fechada e que tiveram evolução desfavorável e arrastada. Pacientes que evoluíram com septação do empiema, persistência de fístula broncopleural de alto débito ou de falta de expansão pulmonar após a drenagem pulmonar foram submetidos a estudo pela tomografia computadorizada e encaminhados para a decorticação pleural precoce como alternativa para o tratamento. Todos os pacientes tratados desta forma tiveram uma rápida melhora clínica, evoluindo com boa expansão pulmonar, recebendo alta hospitalar num prazo máximo de dez dias após a cirurgia. Concluem os autores que tal procedimento é seguro devendo ser considerado para o tratamento do empiema pleural de má evolução.

Unitermos: Decorticação pulmonar; Empiema pleural; Supuração pulmonar crônica.


ABSTRACT

Despite the use of broad spectrum antibiotics and pleural drainage, thoracic empyema in children sometimes fails to improve, being responsible for long hospital stay and mortality rates ranging from 1,5% to 5%. To minimize these problems Kosloske proposed early lung decortication in selected patients. Those patients with empyema septation, persistent bronchopleural fistula or failure of pulmonary expansion were considered to early lung decortication. Reviewing 150 patients at different ages, with thoracic empyema, in a 5 year period, the authors proceeded early decortication in ten. Eighty-one boys and 64 girls aged 1 month to 13 years were first managed with broad spectrum antibiotics and pleural drainage with failure to improve. After a thoracic CT scan evaluation these patients were operated on through a limited thoracotomy having evacuation of intrapleural debris, gelatinous and fibrinous material. The devitalized lung parenchima was resected and the raw surface sewn with 4-0 synthetic absorbable sutures. Good pulmonary expansion and clinical improvement were achieved in all patients. They were discharged home before the tenth postoperative day, in good clmical conditions. There were no deaths and no significant morbidity among those children. The authors conclude that in selected cases early decortication must be considered as a possibility to the treatment.

Key words: Lung decortication; Pleural empyema; Chronic lung suppuration.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS

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Endereço para correspondência:
Dr. Carlos Eduardo Prieto Velhote Rua Carlos Weber 1389/114
05303-000 - São Paulo - SP
E-mail: cevelhote@mandic.com.br

Recebido em 14/9/99
Aceito para publicação em 5/1/2000

 

 

Trabalho realizado no Serviço de Cirurgia Pediátrica do Hospital Carlos Chagas - Guarulhos - São Paulo.

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