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Intractable lung abscess successfully treated with cavernostomy and free omental plombage using microvascular surgery.
显微血管外科技术行空洞造口术和游离网膜充填术成功治疗顽固性肺脓肿

出处: Gen Thorac Cardiovasc Surg   2009   Nov   57 (11) :616-21

作者:Shimizu J;Arano Y;Adachi I;Ikeda C;Ishikawa N;Ohtake H

PMID:19908118

A 68-year-old man, complaining of fever and puriform sputum, was referred to our hospital. A giant abscess was detected in the upper lobe of the right lung. Percutaneous drainage of a lung abscess was carried out. When the pus collected was cultured, Candida was 1+ and Escherichia coli was 2+. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. The contents of the abscess cavity were removed, and the cavity was opened, followed by exchange of gauze every day. For 14 months after cavernostomy, once-weekly gauze exchange was continued at the outpatient clinic to clean the abscess cavity. Finally, the abscess was filled with a free greater omentum flap, accompanied by microvascular anastomosis. In this way, the intractable lung abscess was successfully cured. Conventionally, surgical treatment, particularly cavernostomy, has been applied only to limited cases when dealing with a lung abscess. Our experience with the present case suggests that surgical treatment, including cavernostomy as one option, should also be considered when dealing with lung abscesses resisting medical treatment and causing compromised respiratory function. To enable maximum utilization of the greater omental flap, which is available in only a limited amount, it seems useful to prepare and graft a free omental flap making use of microvascular surgery.

一名主诉为发热和脓样痰的68岁男性被转诊至我院。右肺上叶检测到一个巨大的脓肿。进行经皮肺脓肿引流。收集脓液进行培养,结果示念珠菌属1 +,大肠杆菌2 +。随后引流也难以控制脓肿,我们选择实施空洞造口术。去除了脓腔内容物,打开脓腔,每天更换纱布敷料。 空洞造口术后,患者继续在门诊每周一次更换纱布以清理脓腔,持续14个月。最后,以游离的大网膜瓣充填脓腔,并进行微血管吻合。通过这种方式,顽固性肺脓肿得以治愈。传统上,在处理肺脓肿时,仅在少数病例中使用手术治疗,特别是空洞造口术。我们治疗本病例的经验表明,治疗药物耐药并导致呼吸功能损害的肺脓肿时,也应考虑将包括空洞造口术在内的手术治疗作为一项选择。因为仅有少量大网膜瓣可供利用,为了最大程度地加以利用,采用显微血管外科技术制备和移植游离大网膜瓣似乎有益。