（参考翻译）10.3 empyema-2017.pptVIP

* The organizing phase of empyema requires direct removal of the restrictive coagulum (decortication) with open thracotomy. Open thoracotomy for decortication utilizes a posterolateral thoracotomy incision for access into the pleural space. Fibrosing pleural peel is carefully removed from the parenchymal and parietal pleura. Lung expansion can be assessed prior closure and any remaining peel carefully removed. * Decortication: It is advised for the cases not helped by above procedures. Some studies advocate early decortication to avoid permanent surgical impairment. * Schede’s Thoracoplasty To resect overlying thikened pleural fibrous plate let the chest wall soft tissue including skin, subcutaneous tissue and chest wall muscles get adherent to surface of the lung to eliminate empyema space .It is done for the patient with lung fibrosis because of long-term compression by the thickened pleura. * scoliosis,sunken,dent,pit * Fibrino purulent stage In this stage a large number of poly-morphonuclear leukocytes and fibrin accumulate in the effusion. Pleural fluid pH and glucose level fall while LDH rises. With continued accumulation of neutro-phils and fibrin, effusion becomes purulent and viscous leading to development of empyema. There is progressive tendency towards loculations and formation of a limiting membranes. Pleural fluid analysis shows purulent fluid or pH less than 7.10, glucose less than 40 mg/dl and LDH more than 1000 IU/L. Gram stain and culture reports show microorganism. * Fibrino purulent stage In this stage a large number of poly-morphonuclear leukocytes and fibrin accumulate in the effusion. Pleural fluid pH and glucose level fall while LDH rises. With continued accumulation of neutro-phils and fibrin, effusion becomes purulent and viscous leading to development of empyema. There is progressive tendency towards loculations and formation of a limiting membranes. Pleural fluid analysis shows purulent fluid or pH less than 7.10, glucose less than