[Differential Treatment Strategy of XXXX in a Post-Pneumonectomy Cavity].

@entity1 @entity1143 @entity3509 @entity794 @entity1514 @entity260 @entity281 @entity292 @entity4327
UNASSIGNED: Introduction: @entity4327 in a post-pneumonectomy cavity (PEC) occurs with a frequency of 2%-15% and a mortality of more than 10%. It can occur with or without @entity292 ( @entity292 ). The treatment of @entity3509 in the PEC requires a strict algorithm: drainage, bronchoscopy, closure of the @entity292 , thorough cleaning of the PEC, filling the cavity, thoracoplasty. Methods: 39 cases with an @entity3509 in the PEC were analysed retrospectively ( @entity1 : n=38; @entity1 : n=1; mean age: 60.3  7.6 years). In 32 (82.1%) of the @entity1 , a @entity292 was detected (right: n=26, left: n=6). The average length of stay in hospital was 125 days (22-293 days). Cleaning of the PEC was achieved in all surviving @entity1 (n=23, 65.1%). All @entity1 (n=39) underwent bronchoscopy with placement of a chest tube for drainage. The @entity292 was closed in three cases (7.7%) with a stent while in 12 cases (30.8%) a vascularized flap was used. In 14 @entity1 (35.9%) the bronchial stump was either reclosed with sutures or resected. In three cases (7.7%) a re-anastomosis was performed. Results: The PEC became sterile by regular flushing with antibiotic solution in three @entity1 (7.7%). In 35.9% of the @entity1 (n=14), aggressive surgical debridement (Weder procedure) was necessary. A thoracic window was applied in 22 @entity1 (56.4%), followed by negative pressure wound therapy (NPWT) and change of dressing every three to four days or a tamponade of the @entity1514 with simple dressings. In 19 @entity1 (48.7%) the @entity1514 was sealed with an antibiotic solution. In 5 cases an Alexander thoracoplasty took place. Conclusions: @entity4327 after pneumonectomy still poses a serious @entity260 . A @entity292 is often detected. Thus, two problems arise at the same time - @entity292 and @entity281 in the @entity1143 . Through a strict algorithm, both problems can be dealt with in stages. After sealing the @entity292 , the @entity1514 is thoroughly cleaned and finally the thorax is closed. Only in a small number of @entity1 (1.3%) in whom these measures remain ineffective (persistent @entity794 , aspergillus colonization) should the cavity be obliterated by thoracoplasty.
