10．膿胸における開窓術と有茎筋弁・大網充塡術

Fenestration, Pedicle Muscle Flap, and Omental Plombage for Pyothorax

膿胸はしばしば治療に難渋し，かつ治療期間が長期化することも多く，患者本人の精神的・肉体的苦痛は大きい．膿胸に対する外科治療の現状としては，各施設で患者の状態を考慮しながら行われており，その内容に関しては施設間での格差が大きいと推測される．本稿では有瘻性膿胸や感染コントロール不良例に対する外科治療の基本手技，留意すべき注意点やエッセンスについて解説する．

We sometimes encounter patients with chronic empyema of their thoracic cavity with or without air leakage. These patients suffer from mental and physical problems because of restrictions in daily life and long-term treatment. Pyothorax is divided into acute or chronic empyema. The former is treated by thoracic drainage or debridement under video-assisted thoracic surgery, while the latter is treated by managing the infection and reducing the dead space of the thoracic cavity. In this section, we describe the procedures for some treatment methods and technical skills to manage pyothorax, including fenestration, pedicle muscle flap plombage, omental plombage. The thoracic surgeon should consider the advantages and disadvantages of each method and choose an appropriate technique or possibly a combination of techniques to obtain an optimal outcome in the treatment of pyothorax. The techniques and knowledge described in this section would be useful for many thoracic surgeons’ clinical work. Although the treatment methods differ between institutions, this guideline for thoracic empyema is needed to standardize treatment of this entity in the future.