Lung abscess is a purulent and cavity-forming lesion in the lung. Most acute lung abscesses can be cured by medication, but if treatment is not timely and thorough, it can turn into chronic lung abscess, and then surgical treatment is necessary.
Diagnosis】
1.History, symptoms and physical examination.
2.X-ray examination and chest CT examination. A cavernous lung lesion with thick walls, often with gas-fluid surface, surrounded by infiltrates and striated shadows, with pleural thickening can be seen.
3.Fiber bronchoscopy. To understand the lung and tracheobronchial condition, and to take biopsy.
4.Pulmonary function tests and arterial blood gas analysis, cardiac ultrasound to understand the cardiopulmonary function and assess the risk of anesthesia and surgical tolerance and other problems.
5.Sputum culture plus drug sensitivity test to select sensitive antibiotics.
【Treatment measures
Acute stage lung abscess can be treated with conservative measures such as drug therapy, including systemic application of antibiotics and postural drainage, nebulized inhalation and sputum aspiration by fibrinoscopy. If the above treatment is ineffective, surgical treatment will be considered.
Indications for surgery.
1.The lesion is not obviously absorbed by active medical treatment, and there are more symptoms in persistent or recurrent attacks.
2.Chronic lung abscess with the threat of sudden death by hemoptysis, or hemoptysis that does not stop even after active drug treatment, should be rescued by surgery in time.
3.If chronic lung abscess is difficult to control infection due to high bronchial obstruction, lung resection should be performed after proper preparation.
4.Chronic lung abscess coexisting with other lesions or cannot be completely identified, such as tuberculosis, lung cancer, pulmonary mycobacterial infection, etc., also need pneumonectomy treatment.
Preoperative preparation.
1.Improve the patient’s general condition, strengthen nutrition, intermittent blood transfusion, systemic antibiotics, postural sputum drainage, local spray, endotracheal drops, etc.
2. Sputum volume decreased to less than 50ml per day; sputum changed from yellow pus thick to white sticky thin;
3.Appetite and weight increase;
4.Hemoglobin is close to normal and body temperature and pulse tend to be stable, then surgery can be performed.
Surgery: surgery for lung abscess is difficult, bleeding, and the lesion often crosses lobes; the scope of surgery should not be too conservative, and as far as possible, no lung segment or partial lung lobectomy is done, while most of them exceed the lobe range and even require total lung resection.
Surgical complications: common ones are hemorrhagic shock, bronchial fistula and abscess chest, aspiration pneumonia, esophageal fistula, etc.
Its prognosis, most chronic lung abscesses are treated satisfactorily with surgical treatment, symptoms disappear, and return to normal work.