*For medical professionals only
Percutaneous puncture drainage of lung abscesses is not the treatment of choice for lung abscesses
preface
Lung abscess is the first choice for antibiotic treatment, but many people like to operate and think that putting a drainage tube into it to drain the pus out can achieve an "immediate" effect!
As everyone knows, percutaneous puncture and drainage of lung abscess is not the preferred treatment for lung abscess, this operation involves a lot of medical knowledge, to have enough professional knowledge to weigh the pros and cons to operate, do not do it casually.
Why? To share with you a ridiculous case, you will understand.
1
Classic magical case
Middle-aged people, coughing up sputum for about 3 months.
No fever, no large amounts of pus and sputum, no increased heart rate, no weakness, eating and moving, no malnutrition.
CT revealed a large hole in the lower lobe of the right lung.
Figure 01
The outer courtyard did not know why it considered lung abscess, and also put a large drainage tube in the "pus cavity". This kind of riot operation is not easy to see. Take a look.
Figure 02-05
First of all, we have to admit that the level of this drainage pipe is indeed high! Like an intercontinental missile that hits the target accurately, the drainage tube is placed in the middle of the hollow.
However, show operation requires professional medical knowledge! The appendicitis surgery of killing pigs is certainly worse than that of newly graduated graduate students, but they cannot be doctors because they do not have deep medical skills.
This hollow is a typical lung squamous cell carcinoma. There is no need to put a drainage tube at all.
First of all, the patient has no obvious symptoms of infection! Secondly, this cavity does not have a gas level, nor does it resemble a lung abscess. Finally, the void is a mess, some places are thick, some are thin, the inside of the cavity is uneven, the boundaries around the cavity are clear, and there are no blurry shadows caused by inflammatory reactions. In addition, the patient is middle-aged, which is basically lung squamous cell carcinoma.
Large tubes for lung squamous cell carcinoma are useless and, rarely, may cause tumor spread.
So what happened to this patient?
This drainage tube was put in, nothing was drained out, and it also caused a small amount of pneumothorax.
Figure 06
The patient was transferred to our hospital, the cavity was surgically removed, the case: squamous cell carcinoma of the lung.
2
Can a lung abscess be drained?
Lung abscesses can be drained, provided that antibiotic therapy is not effective, generally preferred to be guided by bronchoscopy, transorheal drainage tubes, so that bronchoprenic fistula can be avoided.
IT is also possible to place a drainage tube percutaneously under CT guidance, but you first need to know what a bronchial pleural fistula is.
Bronchoprenic fistula: The bronchi communicates with the pleura and may lead to an endless pneumothorax.
CT-guided puncture, percutaneous placement of a drainage tube inside the lung abscess, may lead to bronchoprenic fistula, the patient itself has an infection, the fistula may not be easy to grow well, the result is endless pneumothorax!
Some scholars have done meta-analysis, 26 studies were included in the analysis, 194 patients, 17 cases (8.8%) developed serious complications, including bronchoprumic fistula 5 cases (2.6%), 4 cases (2.1%) death.
The likelihood of complicated bronchoprenic fistula is not small.
Unless you have to, don't let the drainage tube on the lung abscess be casually placed.
3
Most lung abscesses do not require the placement of a drainage tube
Most lung abscesses, which can be treated with antibiotics, do not require puncture drainage. Studies have shown that the effectiveness rate of antibiotics is about 80% to 90%.
Studies have shown that the success rate of puncture and drainage of lung abscesses varies from study to study, fluctuating between 55% and 100%.
In practice, most patients do not opt for puncture drainage for lung abscess.
Some scholars in China have done a meteor analysis of lung abscess puncture drainage, included 85 literature, and all the studies are from China, which is really difficult to say.
Foreign scholars have done meta-analysis (puncture and drainage of lung abscess), 26 studies were included in the analysis, and only 194 patients were included in the study, indicating that the vast majority of doctors do not choose this method.
4
Cases of puncture drainage of lung abscess
Antibiotic treatment is really not good, patients and families understand the benefits and risks of puncture drainage, and can also consider puncture drainage.
Example 1
In older men, antibiotic therapy fails. CT shows a large pus cavity in the lower right lobe.
Figure 07
The abscess is punctured, a drainage tube is placed, and after 3 weeks it heals completely.
Figure 08
Example 2
Female 26 years old, lung abscess, 1 week of antibiotic treatment, still fever.
Under CT guidance, the lung abscess is punctured and drained (figures B and C below), followed up after surgery, and the pus is completely drained (figure D below).
Figure 09
Example 3
42-year-old male, fever, lung abscess.
Meropenem and vancomycin are treated with antibiotics. Antibiotic therapy lasted for 5 days and did not show satisfactory clinical results.
Figure 10
It is estimated that it is a familiar scene: the family chases the doctor every day and recites the mantra "Why is it still feverish?" "Do you doctors have a sense of responsibility?" "Is there a conscience?"
What to do?
Under CT guidance, a 10Fr pig's tail catheter is placed inside the lung abscess and the lung abscess is drained. However, only 42 ml of pus is excreted. The patient is still feverish and the lesions in the lungs have increased.
Figure 11
What happened next?
Later, the drainage tube no longer came out with pus, the patient's condition worsened, respiratory failure, endotracheal intubation, on the ventilator!
Look, good patient, you guys are dead!
Replace the large drainage tube directly on the 28Fr pigtail catheter, which is about 3 times the previous one.
The patient is put on a ventilator, has a general anesthesia, a double-lumen tube, single lung ventilation, isolates the left lung (to prevent pus from entering), and is placed in a large drainage tube under X-ray guidance.
Figure 12
The result?
Pressure aspiration of negative 10 cmH2O, drainage of 650 ml of pus at 8 days, detection of Pus oral bacterium, streptococcus vascularis and Clostridium necrosis, antibiotic therapy is downgraded to sulbactam sodium / ampicillin sodium, 5 days later off the ventilator, catheter removed on day 18, discharged after 40 days.
After 7 months, his chest CT confirmed that the lung abscess was completely cured, but left a thin-walled cavity.
brief summary:
Lung abscesses should not be punctured and drained at will, and adequate evaluation should be performed before surgery.
Don't see the empty show operation, others do not show the operation, may be because others are experienced, the old driver does not casually drag.
Families understand and agree that refractory lung abscesses can also be drained.
bibliography:
[1] Oh M,et al. Effective exchange to a larger size catheter for a lung abscess with initial percutaneous drainage failure:a case report. Surg Case Rep.2020.
[2] Kelogrigoris M,et al. CT-guided percutaneous drainage of lung abscesses:review of 40 cases. JBR-BTR.2011.
[3] Lee JH,et al. Percutaneous transthoracic catheter drainage for lung abscess:a systematic review and meta-analysis. Eur Radiol.2022.
Lin Qibin. Relevant research on antibiotics and interventional drainage therapy for lung abscess[D].Wenzhou Medical University, 2020.
[5] Kelogrigoris M,et al. CT-guided percutaneous drainage of lung abscesses:review of 40 cases. JBR-BTR.2011.
This article was first published: Respiratory Channel of the Medical Profession
Author: Sun Danxiong
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