L'EMPIEMA PLEURICO NELL'ADULTO. ESPERIENZA DELLA DIVISIONE DI CHIRURGIA TORACICA DELL'OSPEDALE 'E. MORELLI' DI SONDALO

Between January 1979 and December 1992, 197 adult patients were evaluated for thoracic empyema. Sixty-two (31.5%) of the empyemas occurred as postoperative complications and 135 (68.5%) were considered parapneumonic or jatrogenic. A bronchopleural fistula occurred in 39 (69.6%) patients with postoperative empyema. Fourty of 62 patients (64.5%) with postoperative empyema were successfully treated. The outcome was influenced by the performance status of the patient (p <0.001), by the evidence of bronchopleural fistula (p = 0.002) and by the pulmonary resection performed (p <0.001). In 110 of 135 patients (81%) with non-surgical empyema the surgical treatment was successful. The outcome was only influenced by the performance status of the patient (p <0.001). Sixty-two patients undervent surgical procedures such as empyemectomy and pulmonary decortication (25), pulmonary resection with thoracoplasty (4), muscle transposition (6), thoracoplasty (3), pulmonary resection (39), open window thoracostomy (18), and closure of bronchopleural fistula using a contralateral approach (1). Three (4.8%) died. The choice of treatment must be carefully selected on the patients' health and the ability of each technique to achieve the desired results. A successful treatment depends on a firmly and effective surgical approach.