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A case of empyema with a poor general condition dissected by thoracoscope(LTF-240)under local anesthesia Yasuhiko OHSHIO 1 , Shoji ASAKURA 1 1Department of Thoracic Surgery, Minami-Kyoto Hospital, National Hospital Organization Keyword: 膿胸 , 局所麻酔下胸腔鏡手術 , フレキシブル胸腔鏡(LTF-240) , 線維素溶解療法 pp.197-203
Published Date 2010/4/15
DOI https://doi.org/10.11477/mf.4426100464
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 The patient is a 70-year-old male who visited our hospital with a chief complaint of pain in the left side of the chest in addition to breathing difficulty. Pneumonia in the lower lobe of the left lung and a small amount of pleural effusion in the left side of the chest were observed, wherein the SpO2 was 96%with 10 l/min. of oxygen. Antibiotics were administered, but the pleural effusion in the left side of the chest increased, and pneumonia was also observed in the opposite side. A thoracostomy tube was inserted, but the drainage of the pleural effusion was unsatisfactory. Due to the fact that the patient refused to undergo operation under general anesthesia, we performed the operation under local anesthesia. After rubbing and rupturing the empyema cavity as quickly as possible using a thoracoscope(LTF-240)and inserting two tubes therein, urokinase was then injected into the empyema cavity for 3 consecutive days, and thereafter the dead cavity disappeared. Because there are limitations in the range of motion of a thoracoscope under local anesthesia, no dissection effects similar to those under general anesthesia were obtained, however, it was possible to secure a space for the insertion of a tube in order to proceed with the treatment with fibrinolytics. Consequently, it was possible to avoid general anesthesia, and this method is thus considered to be useful for the treatment of empyema in a patient with a poor general condition.


Copyright © 2010, JAPAN SOCIETY FOR ENDOSCOPIC SURGERY All rights reserved.

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電子版ISSN 2186-6643 印刷版ISSN 1344-6703 日本内視鏡外科学会

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