The treatment principle of acute abscess chest includes three main aspects: systemic treatment, anti-infection and pus drainage. Systemic treatment Encourage patients to eat and drink water, pay attention to replenish electrolytes, and eat more high-calorie, high-vitamin and high-protein diet, and give intravenous rehydration to patients with critical condition and weakness, and if necessary, input intravenous nutrition, plasma, albumin or fresh blood for several times to correct anemia and enhance resistance to promote early recovery. Anti-infection Extract pus from the chest cavity for bacterial culture and drug sensitivity test as soon as possible, and select sensitive and effective antibiotics to control the disease as soon as possible. Pus drainage 1.Thoracentesis In the early stage of some acute abscess chest, the pus is thin and can be easily extracted by thoracentesis. As long as the puncture site is well chosen, it can be successfully punctured. The puncturing physician should personally take a chest X-ray to understand the scope of abscess chest and determine the thoracic puncture site under fluoroscopy, if it is a limited abscess chest, the site with the largest diameter of abscess cavity should be taken for puncture first. If it is a full septic chest, the site should be selected at the 7th intercostal space in the posterior line of the internal organs. When puncturing, the patient should be allowed to adopt a comfortable position, usually in a semi-sitting position or sitting in front of a small table with the arms lying on the table to avoid excessive fatigue of the patient and to facilitate the puncture operation. Local anesthesia with 2% procaine or lidocaine is used. The puncture needle should be a thick needle of 18 to 22 gauge, with a length of 5 cm or more, otherwise it is difficult to puncture the chest wall. The puncture should be done along the upper edge of the rib cage to avoid injury to the intercostal neurovascular, and the tip of the needle generally points to the posterior upper part of the patient so that the needle sprays into the chest cavity close to the chest wall, which is less likely to damage the lung tissue. Before the tip of the needle enters the chest cavity for a large amount of fluid extraction, the needle can be pushed in again about 0.5-1 cm, and the bevel of the needle tip is directed toward the chest wall, which can avoid the tip of the needle coming out of the chest cavity during the puncture process, and can also avoid the lung tissue expanding and blocking the tip of the needle to facilitate the fluid extraction. The pus should be extracted as much as possible during each thoracentesis, and after the pus is extracted, an appropriate amount of sensitive antibiotics should be injected into the chest cavity via the puncture needle. Part of the abscess chest can be cured by repeated thoracentesis and systemic treatment. Due to the different pathogenic bacteria and viscous pus, which cannot be easily extracted by puncture needle, it can be flushed into the chest cavity by puncture needle during puncture, and after extracting part of the pus, inject equal amount of saline or 2% sodium bicarbonate solution and fibrinolytic drugs, such as trypsin, and flush repeatedly until the extracted fluid becomes clear. Note that the amount of flushing fluid injected each time should not exceed the total amount of fluid extracted, so as not to cause an increase in pressure in the chest cavity, which may spread the pus to other parts and cause the infection to spread. The reason why the thoracic puncture method is not easy to completely cure the abscess chest is that as the condition gradually improves, the abscess cavity becomes smaller and smaller, and it is more and more difficult to locate the puncture, and sometimes some of the abscess cavity will remain and cannot be completely eliminated. 2.Closed thoracic drainage Acute abscess thorax is fast-onset, the fluid is many and sticky, the condition is critical, there are symptoms of poisoning, and the fluid is rapidly generated after thoracentesis, closed thoracic drainage is needed; combined with bronchopleural fistula or esophageal pleural fistula abscess pneumothorax, closed thoracic drainage is also needed. Closed chest drainage can be performed by trocar puncture and placement method under local anesthesia, incising the skin about 0.5 cm, stabbing the trocar into the chest cavity through the intercostal space, withdrawing the metal core, feeding the drainage tube through the jacket tube, then withdrawing the jacket tube, fixing the skin and connecting the drainage bottle. This method is easy to operate, but the drainage tube put in is limited by the jacket tube, which is generally thin, and the drainage is not smooth and cannot meet the needs of treating abscess chest, and in addition, when the jacket tube is withdrawn, it will cause contamination around the drainage tube and cause infection, so that the seal around the drainage tube is reduced or even disappeared, and thus the lung reopening is somewhat affected. Intercostal incision and drainage method after local anesthesia, cut the skin about 2 cm, use hemostatic forceps to purely separate the layers of muscle, straight to the chest cavity, and then clamp the front end of the drainage tube with curved hemostatic forceps and insert it directly into the chest cavity. This method can insert thicker drainage tubes, but the operation is more complicated and requires a certain degree of anatomical knowledge and experience. In recent years, various types of special drainage tubes for closed chest drainage have been widely used. This method is to cut the skin under local anesthesia about 1 cm, and then insert the anti-drainage tube directly into the chest cavity, exit the needle core after reaching a certain depth, fix and connect the drainage bottle to complete the operation of closed chest drainage. This method is convenient and quick, no pollution around the drainage tube, the thickness of the drainage tube can be selected according to the need, the advantages are outstanding, so it is widely used, the effect is satisfactory. 3.Interventional treatment The wrapped abscess thorax is usually found in the parietal sulcus of the rash column, and it is inconvenient to place closed drainage in the thorax because of the location, and if the drainage tube is placed in the back, the patient cannot lie down and seriously affects the rest, which is difficult for the patient to accept. The authors have borrowed the method of vascular puncture placement for years to perform drainage and irrigation of the pus cavity and obtained satisfactory results. After local anesthesia with 2% procaine or lidocaine, a venipuncture needle is inserted into the abscess cavity, the pus is withdrawn, the tip of the needle is confirmed to be in the abscess cavity, a metal guidewire is placed and the venipuncture needle is withdrawn, a pigtail-shaped catheter for cardiovascular imaging is placed along the metal guidewire, the pus is withdrawn and repeatedly flushed through the catheter, and antibiotics and fibrinolytic drugs can also be injected. The advantages of this method are: ① the catheter is thin and soft, which is less painful to the patient and does not affect lying down; ② the front end of the catheter is pigtail-shaped, which does not damage the tissue, so it can be advanced with confidence and boldness, while the fibrin separation in the pus cavity is opened to make it a pus cavity for drainage: ③ the catheter is impervious to X-rays, which makes it easy to observe the size of the pus cavity under fluoroscopy. ④The pus cavity is gradually shrinking at the beginning of the healing process, and the catheter can be gradually withdrawn, but as long as the pus can still be extracted it is confirmed that the catheter is still in the pus cavity, which overcomes the difficulty of finding the pus cavity at the end of repeated thoracentesis; ⑤The catheter is thin, and there is no need to change the medication when the catheter is removed after healing of the pus cavity. This method has many advantages and exact efficacy, so it is expected to be widely used in the future.