The Interventional Therapy Of The Huge Lung Abscess By Implanting Catheter Via The Chest Wall And Tamponading The Bronchus With Fibrin Glue

Objective: Lung abscess is the purulent inflammation in lung tissue which is because of various infectious agent. Then the affected lung tissue degenerates, necrosis, colliquates and then forms the abscess by granulation tissue encased. The whole body applies antibiotic and postural drainage, which is the basic treatment of the lung abscess. However, simply depended on this treatment, it is often difficult to control and cure it timely and effectly such as these cases: huge lung abscess, tono-lung abscess, some secondary lung abscess like echmasis lung abscess, lung tuberculous cavity, lung carcinomatous cavity, lung cyst secondary infection, chronic lung abscess or who have exhaustion ,serious malnutrition, diabetes and serious heart and lung affection. Thus leads to protraction, aggravate, various complications such as empyema pneumopyothorax, bronchop- leural fistula, septicemia, pyemia chronic lung abscess and even toxic shock. The operation of opening the chest is a modus operandi especially for chronic lung abscess and some secon- dary lung abscess. But it incompetents the late lung cancer, eld, wholly exhaustion, serious malnutrition, diabetes and serious cardiorespiratory function damaged patients. In fact punctio, drawing pus, flushing and injecting medicine into lung abscess under B type supersound or CT guidance via the chest wall are simple and effective treatment. While each time the patient's body posture is confined; transfixion pin stays too long time in vomica; after part of pus was drew out, vomica will minify and it is easy for needle tip to metachoresis.When the vomica is washed, the douche often contraflows to the airway and causes bucking. At this moment the internal pressure in abscess ascen- sus suddenly, and it is easy for the pus and gas in vomica to enter into the chest, lung interstitial substance or hypo. through the chest wall and causes empyema, pneumopyothorax, pne- umoderma, interstitial emphysema, emptysis and the visceral pleura and partial pleura allotopia and the needle tip dislocates; and the punct 1-2 times a week,what's more it needs many times to achieve the goals of treatment and can't bring out much convenience to the clinic.Implanting the catheter into vomica via chest wall is an effective treatment, yet acturally it is difficult for the tip of the catheter to be placed at the best position exactly. The patient often needs to change their posture, it is difficult for serious exhaustion to combinate, and when the vomica is washd, the douche often contraflows to the airway and causes bucking. At this moment the internal pressure in abscess ascensus suddenly, and it is easy for the pus and gas in vomica to enter into the chest, lung interstitial substance or hypo. through the chest wall catheter and causes empyema, pneumopyothorax, pneumoderma, interstitial emphysema, emptysis and the visceral pleura and partial pleura allotopia and the catheter dislocates; fewers'take on tension. The gas unceasingly enter into vomica in the course of breathing. When the catheter is in inadequate drainage, em- pyema and pneumopyothorax will be induced even aggravately.Compared with the treatment of singly applying antibiotics and postural drainage, the interventional therapy of huge lung abscess by implanting catheter via chest wall and tamponading the bronchus with fibrin glue will be studied in the research to approach its therapeutic effect and its safety for supplying a new easy, safe and effective way in clinic.Methods: The respiratory department in the fourth hospital of Hebei medical university accepted 36 huge lung abscess cases form May, 2002 to November, 2006.The patients corre- spond the diagnostic critera of the lung abscess whose diameter≥10cm. Among them there are 23 males and 13 females who averagely aged 59.8±12.9 years old(31~82). Their diameter 13.2±1.4cm (10.0~15.6). 17 cases are primary lung abscess; 19 secondary lung abscess, and 9 lung cancers, 5 esophageal car- cinoma, 2 lung tuberculosis, 1 lung cyst and 2 others. The locations of the lung abscess: 5 superior lobe, 7 middle lobe, and 11 lower lobe of the right lung; 4 superior lobe and 9 lower lobe of the left lung. And their body temperatures 39.2±0.6℃,the total white blood cells(20.7±4.3)*109. The KPS score before treatment: There are 6 cases whose score were 40 or below 40, 13 cases were 50, 10 cases were 60 and 7 cases were 70 or above 70. 36 cases huge lung abscess patients are randomly divided into two groups. Control group:18 cases lung abscess patients, uses the internal medicine department convention treatment by resisting bacteria, the body posture drainage and the just right for the illness support therapy (namely penicilin and quinolones antibiotic such as Enoxacin, moxifloxacin and so on, or the third generation cephalosporin like cepoperazon, Ceftazidime or carbapenem antibioics like tienam Meropenem and so on, anti-anaerobian like arilin , Tinidazole , pyretolysis, eliminating phlegm, preventing cough, conquering wheeze and nutritional support therapy).Study group: 18 cases lung abscess patients, based on the control group internal medicine department convention resist bacteria, the body posture drainage and in the just right for the illness support therapy, the interventional therapy of the huge lung abscess by implanting catheter via the chest wall and tamponading the bronchus with fibrin glue will be used. Namely implanting the central venous catheter via the chest wall into the lung abscess under the CT guidance, drawing out the pus, flushing the vomica and injecting the antibiotic into the vomica through the central venous catheter (amikacin, arilin or other antibiotic based on susceptibility test), when the amount of purulent sputum obviously reduces or vanishes pours fibrin glue to tamponade the bronchus in which the lung abscess lies through the bronchofibroscope.Both growps were comparable with respect to age, the sex, abscess diameter, lung abscess type, KPS grading and so on. The observation treatment time is 4 weeks, Compare the two groups of patients at pneumonia infiltrate shadow, the cavitates diameter change, length of stay, the time of body temperature falling to the normal, the cough and expectoration vanishing time, the time of white blood cell falling to the normal, the complication, the KPS score at pretherapy and post-treatment, and the effect on the two kind of locating bronchus methods in which the lung abscess situates.Results1 Imageology evaluate1.1 Therapeutic effect: 4 weeks after treatment curing 10 cases in study group, 1 case in the control group; 16 cases are utility in the study, 4 cases in the control group, the effective power is 88.9% in the study group, 22.2% in the control group. There are significant difference at the therapeutic effect between the two groups(P<0.05).1.2 The relationship between the type of lung abscess and clinic therapeutic effect: In the study group, there are 7 effective cases in primarily lung abscess, 9 in secondary lung abscess, effective power are 87.5% and 90%, There are non-significant difference in therapeutic effect between primarily lung abscess and secondary lung abscess, P>0.05.In the control group, 3 in primarily lung abscess; 1 in secondary lung abscess; effective power are 33.3% and 11.1%, There are non-significant difference in therapeutic effect between primarily lung abscess and secondary lung abscess, P>0.05.In the study group there are 7 effective cases in primarily lung abscess and its effective power is 87.5%.While in the control group 3 in primarily lung abscess and effective power is 33.3%.There are significant difference between them, P< 0.05;In the study group 9 in the secondary lung abscess and effective power is 90%.In the control group 1 in secondary lung abscess and effective power is 11.1%.There are significant difference between them, P< 0.05.2 Body temperature: In the study group, there are 12 cases whose temperature drop to normal after one week treatment, 3 after two weeks, 1 after three weeks, 1 after four weeks, the total effective power is 94.4%. While in the control group, 0 after one week, 1 after two weeks, 1 after three weeks, 2 after four weeks, the total effective power is 22.2%. There are significant difference between the two groups, P<0.05.3 Cough and expectoration: In the study group, there are 11 cases whose cough and expectoration were complete remission after one week treatment, 3 after two weeks, 1 after three weeks, 1 after four weeks, the total effective power is 88.9%. While in the control group, 0 after one week, 1 after two weeks, 1 after three weeks, 1 after four weeks, the total effective power is 16.7%, there are significant difference between the two groups, P<0.05.4 White blood cell detection: In the study group, there are 11 cases whose white blood cell drop to normal after one week treatment, 3 after two weeks, 1 after three weeks, 1 after four weeks, the total effective power is 88.9%. While in the control group, 0 after one week, 1 after two weeks, 1 after three weeks, 1 after four weeks, the total effective power is 16.7%. There are significant difference between the two groups, P<0.05.5 Length of stay: In the study group the average stay is 18.0±2.8 days, while in the control group it is 37.6±9.2 days. There are significant difference at length of stay between the two groups, (P<0.05).6 KPS score: The patients'quality of life. To evaluate the patients'quality of life by KPS score. To compare the two groups of patients'KPS score when the treatment is over after 4 weeks. There are significant difference between the two groups, P<0.05.To compare the KPS score in the study group between pretherapy and post-treatment, There are significant difference between them, P<0.05. To compare the KPS score in the control group between pretherapy and post-treatment, There are non-si gnificant difference between them, P>0.05.7 To compare the complication of the two groups: In the study group there are 1 case of empyema, 1 pneumopyothorax, 1 pneumoderma, 1 hemoptysis and 2 exhaustion. In the control group, 3 empyema, 3 pneumopyothorax, 2 hemoptysis, 7 exhaustion and 1death. There are significant difference between the two groups, P>0.05.8 To compare the two locating bronchus methods in which the lung abscess situates: There are 10 cases were located by the method that diluted solution of Methylene Blue was injected into vomica via the chest wall catheter, and 9 cases were succeed. There are 8 cases were located by the method of simple observation, and 5 cases were succeed. Their effective power was 90% and 62.5%. There are nonsignificant difference between the two methods, P>0.05.Conclusion:①The effective power is 88.9% in the study group, while its 22.2% in the control group. There are significant difference between them, P<0.05. The study group's therapeutic effect is obviously higher than the control group's. The study group body temperature falls to the normal time, the cough, vomica vanishing time, the white blood cell restores the normal horizontal time, hospital days obviously is short in the control group, two groups of comparisons have the obvious statistics difference (P<0.05). Two groups complication are not obvious statistics difference (P>0.05), considered that it is concerned with little amount of the sample. From now on we will increase the sample amount to do further compares.The locating bronchus methods in which the lung abscess situates: To compare the method that diluted solution of Methylene Blue was injected into vomica via the chest wall catheter and the simple judgment method under the bronchofibroscope. There are not obvious statistics difference between them, but possibly it is concerned with the little amount of sample.②This research discover the interventional therapy of the huge lung abscess by implanting catheter via the chest wall and tamponading the bronchus with fibrin glue is one kind simple, safe and the effective new method. Suits specially in the huge lung abscess, the tono-lung abscess, certain secondary abscess like blocking lung abscess, pulmonary tuberculosis cavity, the lung cancer cavity, the lung cyst secondary infection, the chronic lung abscess or has the whole body failure, the serious malnutrition, diabetes, have the serious heart and lung affection patient long treatment to be invalid, unfit to the chest surgery.