A new sterilization technique with balloon-tube thoracostomy for thoracic empyema.
OBJECTIVE
Failure or prolongation of treatment for refractory thoracic empyema by the current chest-tube drainage technique is often due to sterilization difficulties. Insufficient sterilization prolongs hospitalization, and is often associated with life-threatening complications and/or additional invasive surgical procedures. A new chest-tube sterilization technique aimed at making it less invasive and shortening the therapy is proposed.


METHODS
Following pretreatment for complications including loculation, bronchopleural fistula, or corticated lung, a double-lumen trocar catheter was introduced at the bottom of the empyemic cavity through the lateral chest wall. Then, a Foley balloon urethra-catheter was inserted and attached just inside the anterior chest wall at the top of the cavity for the evacuation of intrathoracic air. After irrigation of the cavity with distilled water once or twice, the cavity was completely filled with a bactericidal solution which was left in place for 30-60 minutes, followed by an antibiotic solution for more than 20 hours.


RESULTS
Among the five treated post-lobectomy or pneumonectomy cases, sterilization was obtained after only one treatment in four cases and after two courses in the other. Catheterization duration from the initial treatment was 2-13 days. Neither recurrence nor treatment-related major complications were observed.


CONCLUSIONS
This balloon-tube thoracostomy technique is simple, minimally invasive and cost-effective, due to shortening of the treatment time with minimal manpower and equipment requirements. It is thus a promising therapeutic approach to thoracic empyema and has the potential for application to other intrathoracic disorders.
Kadoyama
Chikabumi
C
Department of Thoracic Surgery, Saitama Red Cross Hospital, Saitama, Japan.
Ishikawa
Aki
A
Shiba
Mitsutoshi
M
Yasufuku
Kazuhiro
K
Hoshino
Hidehisa
H
Suwa
Toshikazu
T
Fujisawa
Takehiko
T
D000368:Aged; D002404:Catheterization; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013242:Sterilization / Q000379:methods*; D013907:Thoracostomy / Q000379:methods*