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Artigos Originais • Rev. Col. Bras. Cir. 27 (1) • Fev 2000 • https://doi.org/10.1590/S0100-69912000000100009   copiar

Decorticação pleural precoce no tratamento do empiema pleural complicado na criança

Early decortication in the management of complicated empyema in children

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumos

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.

Decorticação pulmonar; Empiema pleural; Supuração pulmonar crônica

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.

Lung decortication; Pleural empyema; Chronic lung suppuration

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

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.

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Full text available only in PDF format.

REFERÊNCIAS

1. Chan W, Keyser-Gauvin E, Davis GM, et al. Empyema thoracis in children: a 26-year review of the Montreal Children's Hospital. J Pediatr Surg 1997;32:870-872.

2. Stouroff M, Teague G, Heiss KF, et al. Thoracoscopy in the management of pediatric empyema J Pediatr Surg 1995;30:1.211- 1.215.

3. Strange C, Sahn AS. Management of parapneumonic pleural effusions and empyema. Infect Dis Clin North Am 1991;5:539-559.

4. Gocmen A, Kiper T, Topraw M. Conservative treatment of empyema in children. Respiration 1993;60:182-185.

5. Velhote CEP, Cagnolati CA, Oliveira TF, et al. Valor da infusão em bolo de bupivacaína 0,25% no controle da dor pós-operatória na cirurgia abdominal na criança. Rev Col Bras Cir 1995;22:317-320.

6. Chonmaitree T, Powell KR. Parapneumonic effusion and empyema in children. Review of a 19 year experience 1962-1980. Clin Pediatr 1983; 22:414-419.

7. Renner H, Gabor S, Pinter H, et al. Is agressive surgery in pleural empyema justified? Eur J Cardiothorac Surg 1998;14:117-122.

8. Paris F, Ruiz-Company S, Asenzi F, et al. Complications of lower respiratory tract infection: Empyema complicating pneumonia, pneumatoceles, and respiratory embarassment (Discussion), in Fallis JC, Filler RM, Lemoine G (eds): Pediatric Thoracic Surgery, New York, NY: EIsevier Science, 1991, pp 308-310.

9. Eren N, Ozcelic C, Ener BK, et al. Early decortication for postpneumonic empyema in children. Effect on pulmonary perfusion. Scand J Thorac Cardiovasc Surg 1995;29:125-129.

10. Vilarrodona HO, Reynoso MC. Empiema e mediastinite. In Maksoud JG - Cirurgia Pediátrica, Rio de Janeiro: Editora Revinter Ltda 1998, pp 583-591.

11. Rizalar R, Somuncu S, Bernay F, et al. Postpneumonic empyema in children treated by early decortication. Eur J Pediatr Surg 1997; 7:135-137.

12. Kosloske AM, Cushing AH, Shuck JM. Early decortication for anaerobic empyema in children. J Pediatr Surg 1980;15:422-426.

13. Khakoo GA, Goldstraw P, Hansell DM, et al. SurgicaI treatment of parapneumonic empyema. Pediatr Pulmonol 1996;22:348-356.

14. Foglia RP, Randolph J. Current indications for decortication in the treatment of empyema in children. J Pediatr Surg 1987;22:28-33.

15. Gofrit ON, Engelhard D, Abu-Dlu K. Post-pneumonic thoracic empyema in children; a continued Surgical challenge. Eur J Pediatr Surg 1999;9:4-7.

16. Gustafson RA, Murray GF, Warden HE, et al. Role of lung decortication in symptomatic empyemas in children. Ann Thorac Surg 1990; 49:946-947.

17. Carey JÁ, Hamilton JR, Spencer DA, et al. Empyema thoracis: a role for open thoracotomy and decortication. Arch Dis Child 1998; 79: 510-513.

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.

  • 1. Chan W, Keyser-Gauvin E, Davis GM, et al. Empyema thoracis in children: a 26-year review of the Montreal Children's Hospital. J Pediatr Surg 1997;32:870-872.
  • 2. Stouroff M, Teague G, Heiss KF, et al. Thoracoscopy in the management of pediatric empyema J Pediatr Surg 1995;30:1.211- 1.215.
  • 3. Strange C, Sahn AS. Management of parapneumonic pleural effusions and empyema. Infect Dis Clin North Am 1991;5:539-559.
  • 4. Gocmen A, Kiper T, Topraw M. Conservative treatment of empyema in children. Respiration 1993;60:182-185.
  • 5. Velhote CEP, Cagnolati CA, Oliveira TF, et al. Valor da infusăo em bolo de bupivacaína 0,25% no controle da dor pós-operatória na cirurgia abdominal na criança. Rev Col Bras Cir 1995;22:317-320.
  • 6. Chonmaitree T, Powell KR. Parapneumonic effusion and empyema in children. Review of a 19 year experience 1962-1980. Clin Pediatr 1983; 22:414-419.
  • 7. Renner H, Gabor S, Pinter H, et al. Is agressive surgery in pleural empyema justified? Eur J Cardiothorac Surg 1998;14:117-122.
  • 8. Paris F, Ruiz-Company S, Asenzi F, et al. Complications of lower respiratory tract infection: Empyema complicating pneumonia, pneumatoceles, and respiratory embarassment (Discussion), in Fallis JC, Filler RM, Lemoine G (eds): Pediatric Thoracic Surgery, New York, NY: EIsevier Science, 1991, pp 308-310.
  • 9. Eren N, Ozcelic C, Ener BK, et al. Early decortication for postpneumonic empyema in children. Effect on pulmonary perfusion. Scand J Thorac Cardiovasc Surg 1995;29:125-129.
  • 10. Vilarrodona HO, Reynoso MC. Empiema e mediastinite. In Maksoud JG - Cirurgia Pediátrica, Rio de Janeiro: Editora Revinter Ltda 1998, pp 583-591.
  • 11. Rizalar R, Somuncu S, Bernay F, et al. Postpneumonic empyema in children treated by early decortication. Eur J Pediatr Surg 1997; 7:135-137.
  • 12. Kosloske AM, Cushing AH, Shuck JM. Early decortication for anaerobic empyema in children. J Pediatr Surg 1980;15:422-426.
  • 13. Khakoo GA, Goldstraw P, Hansell DM, et al. SurgicaI treatment of parapneumonic empyema. Pediatr Pulmonol 1996;22:348-356.
  • 14. Foglia RP, Randolph J. Current indications for decortication in the treatment of empyema in children. J Pediatr Surg 1987;22:28-33.
  • 15. Gofrit ON, Engelhard D, Abu-Dlu K. Post-pneumonic thoracic empyema in children; a continued Surgical challenge. Eur J Pediatr Surg 1999;9:4-7.
  • 16. Gustafson RA, Murray GF, Warden HE, et al. Role of lung decortication in symptomatic empyemas in children. Ann Thorac Surg 1990; 49:946-947.
  • 17. Carey JÁ, Hamilton JR, Spencer DA, et al. Empyema thoracis: a role for open thoracotomy and decortication. Arch Dis Child 1998; 79: 510-513.
  • Endereço para correspondência:
    Dr. Carlos Eduardo Prieto Velhote Rua Carlos Weber 1389/114
    05303-000 - São Paulo - SP
    E-mail:

    • Datas de Publicação

    • Publicação nesta coleção
      31 Jul 2009
    • Data do Fascículo
      Fev 2000

    Histórico

    • Aceito
      05 Jan 2000
    • Recebido
      14 Set 1999
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