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Staged removal of artificial patches for thoracic empyema after extrapleural pneumonectomy for diffuse malignant pleural mesothelioma
General Thoracic and Cardiovascular Surgery ( IF 1.1 ) Pub Date : 2021-10-21 , DOI: 10.1007/s11748-021-01723-0
Makoto Sonobe 1 , Yuuki Kou 1 , Nobuhisa Yamazaki 1 , Yasuto Sakaguchi 1 , Hirokazu Tanaka 1
Affiliation  

A 69-year-old man with occupational exposure to asbestos was referred to our hospital with right diffuse malignant pleural mesothelioma. He underwent extrapleural pneumonectomy with reconstruction of the pericardium and diaphragm using elongated polytetrafluoroethylene patches, followed by postoperative chemotherapy and chest wall irradiation. One year later, he was hospitalized because of a right empyema caused by Escherichia coli infection. As chest drainage and systemic antibiotics did not eliminate the abscess around the artificial patches, a Clagett window was created. To avoid mediastinal and liver overshift into the right thoracic cavity, we only performed partial resection of the diaphragm patch and incision of the artificial pericardium. After 19 days of irrigation and dressing change, the artificial patches were completely removed. Two months later, the patient provided a culture-negative sample and had an improved nutritional status; we therefore performed closure of the Clagett window with thoracoplasty. He did not experience recurrence of empyema.



中文翻译:

弥漫性恶性胸膜间皮瘤胸膜外全肺切除术后胸腔积脓人工补片分期去除

一名 69 岁男性因职业性接触石棉而因右侧弥漫性恶性胸膜间皮瘤被转诊到我院。他接受了胸膜外全肺切除术,使用细长的聚四氟乙烯贴片重建心包和膈肌,然后进行术后化疗和胸壁照射。一年后,他因大肠杆菌引起的右侧脓胸入院感染。由于胸腔引流和全身抗生素并未消除人工斑块周围的脓肿,因此创建了一个 Clagett 窗口。为了避免纵隔和肝脏过度移位到右胸腔,我们只进行了膈肌贴片的部分切除和人工心包的切口。经过 19 天的冲洗和换药后,人工贴片被完全去除。两个月后,患者提供培养阴性样本,营养状况有所改善;因此,我们通过胸廓成形术关闭了 Clagett 窗。他没有经历脓胸复发。

更新日期:2021-10-22
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