Abstract
Objectives: To evaluate lung function after lung decortication in patients operated for chronic
pleural empyema. Methods and Materials: To determine the lung function after lung decortication in 20 men (71.4 %) and 8
women (28.6 %) a prospective evaluation of blood gases, spirometry, lung perfusion,
ventilation, and alveolar permeability were performed 28 weeks (15 - 60 weeks) after
the operation. Results: Median lung perfusion on the affected side was 45.2 % (26.1 - 55.3 %) in 13 right
and 36 % (13.8 - 47.2 %) in 15 left empyemas, and was within normal limits in 4/28
cases. The mean lung ventilation was 44.4 % (21.5 - 54 %) and 37 % (18.9 - 50.6 %)
in patients affected on the right or left side, respectively. Ventilation perfusion
inequality occurred in 22 patients (78.6 %). Dynamic ventilation scintigraphy revealed
impairment of epithelial integrity in 10 cases (35.7 %). Individual analysis revealed
that 15 patients (53.6 %) showed a severe reduction in one of the examinations and
8 (28.6 %) in more than one. Conclusions: Although the separate analysis of the different functional parameters revealed a
mild reduction of lung function after decortication, in the majority of patients the
impairment was more severe due to multilevel functional lung damage.
Key words
Chronic pleural empyema - lung function - lung decortication - scintigraphy
References
- 1
Ahmed F A, Harrison C V.
The effect of prolonged pulmonary collapse on the pulmonary arteries.
J Path Bact.
1963;
85
357-360
- 2
Björk V O, Salen E F.
The blood flow through an atelectatic lung.
J Thorac Cardiovasc Surg.
1950;
20
933-942
- 3
Benfield J R, Long E T, Harrison R W. et al .
Should a chronic atelectatic lung be re-aerated or excised?.
Dis Chest.
1960;
37
67-74
- 4
Long E T, Adams W E, Benfield J E. et al .
Altered hemodynamics in the pulmonary circulation following re-aeration of an atelectatic
lung.
J Thorac Cardiovasc Surg.
1960;
40
640-651
- 5
Morton J R, Boushy S F, Guinn G E.
Physiological evaluation of results of pulmonary decortication.
Ann Thorac Surg.
1970;
9
321-326
- 6
Petro W, Maassen W, Greschuchna D. et al .
Regional and global lung function in unilateral fibrothorax after conservative therapy
and decortication.
Thorac Cardiovasc Surg.
1989;
30
137-141
- 7
Swoboda L, Laule K, Blattmann H. et al .
Decortication in chronic pleural empyema. Investigation of lung function based on
perfusion scintigraphy.
Thorac Cardiovasc Surg.
1990;
38
359-361
- 8
Thomas G I, Jarvis F J.
Decortication in primary tuberculous pleuritis and empyema with a study of functional
recovery.
J Thorac Surg.
1956;
32
178-189
- 9
Toomes H, Vogt-Moykopf I, Ahrendt J.
Decortication of the lung.
Thorac Cardiovasc Surg.
1983;
31
338-341
- 10
Toomes H, Linder A, Friedel G.
Funktionelle Aspekte des Pleuraempyems und der Pleuraschwiele.
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir.
1989;
199-202
- 11
Skokowski J, Rzyman W, Brasławska J.
Traumatic rupture of the left main bronchus - late surgical treatment.
Ann Acad Med Gedan.
1994;
24
101-103
- 12
Wolfart W.
Szintigraphische Untersuchungen vor und nach Dekortikation der Lunge.
Thoraxchirurgie.
1974;
22
435-439
- 13
Wójcik J, Sedlaczek A, Grodzki T. et al .
Pulmonary flow in patients subjected to lung decortication due to chronic pleural
empyema.
Pol Przegl Chir.
1998;
70
29-37
- 14
Rzyman W, Romanowicz G, Skokowski J. et al .
Decortication in chronic pleural empyema: Effect on lung function.
Eur J Cardiothorac Surg.
2002;
21
502-507
- 15 Standardised lung function testing. Interim Report of the Working Party “Standardisation
of Lung Function Tests” of the European Community for Coal and Steel. Luxembourg;
European Community for Coal and Steel 1981
- 16
Dusser D, Collignon M AG, Leguern G S. et al .
Respiratory clearance of DTPA and pulmonary involvement in sarcoidosis.
Am Rev Resp Dis.
1986;
3
493-497
- 17 Cotes J E. Lung Function. Warszawa; PZWL 1969
- 18 Slome D.
Physiology of respiration. Evans FT, Gray TC General Anaesthesiology. Warszawa; PZWL 1970: 55-140
- 19
Konietzko N, Brandstetter F, Steinberg.
Die gefesselte Lunge - Ergebnisse der Dekortikation. Atemwegs- u.
Lungenkrankheiten.
1980;
6
191-200
- 20
Chan T L, Lippmann M.
Experimental measurements and empirical modelling of the regional deposition of inhaled
particles in humans.
Am Ind Hyg Assoc J.
1980;
41
399-409
M.D. Ph.D. Witold Rzyman
Thoracic Surgery Department
Medical University of Gdansk
Ul. Dębinki 7
80-211Gdansk
Poland
Phone: + 48583492400
Fax: + 48 5 83 49 24 29
Email: wrzyman@amg.gda.pl