9．術後創感染，膿胸の予防における留意点と発生時の対策

Management of Postoperative Surgical Site Infection and Empyema After Thoracic Surgery

胸部外科手術後の創感染，膿胸は術後在院期間の延長の原因となる．表層部の創感染であっても，胸腔と交通して膿胸へ移行することもあるため，予防とともに発症後の対処は早急かつ適切に行う必要がある．有瘻性膿胸と無瘻性膿胸では治療方針が異なる．肺切除後の有瘻性膿胸であれば迅速な対応が必要であるため，早期の診断が重要である．

Surgical site infections （SSI）［wound infection, empyema］ after thoracic surgery can lead to severe complications. Targeted antibiotic treatment and drainage are the keys. For the treatment of postoperative empyema without bronchopleural fistula, chest tube thoracostomy and irrigation with normal saline is effective. For postoperative empyema with bronchopleural fistula, open window thoracotomy is a good treatment option. Since the condition of empyema is different in each patient, treatment should be individualized depending on the patient’s condition.