Surgical treatment of lung abscess

If lung abscess is not diagnosed and treated in time, it can progress to chronic, difficult to treat, or cause dangerous and life-threatening complications. Lung abscess surgery is used when other treatments have failed.

Lung abscess is a collection of pus in the lung parenchyma due to an acute non-tuberculosis infection, after oozing pus to form a cavern, the pus of the abscess is necrotic substances and degenerate leukocytes. Lung abscesses may have one or more foci. If medical treatment fails after 6 weeks, it is called a chronic lung abscess, at which time a fibrous capsule has formed in the cavity of the abscess.
Abscessary pneumonia usually develops in the following stages:
The purulent stage This is an easy stage to misdiagnose, because the patient has initial symptoms as an acute bacterial pneumonia . The patient has a fever of 39-40oC, local chest pain, shortness of breath, dry cough or coughing up purulent mucus. The lungs have few crackles and crackles. Blood tests showed an increased white blood cell count and a higher than normal percentage of polymorphonuclear leukocytes. The X-ray image is an indistinct, relatively wide opacity with no focal point of destruction.
If the patient is given appropriate antibiotics at this stage, the clinical symptoms will gradually decrease, the disease will not turn to the purulent stage. If the patient is not treated or treated with antibiotics is not thorough, the disease will develop through the purulent stage.
Stage of spitting up pus After 5-15 days, the patient will spit up pus, but there are also cases where the patient spits up pus a few weeks later. Before spitting up pus, the patient has symptoms of coughing more, coughing up blood, bad breath if the cause of lung abscess is anaerobic bacteria. After a few strong coughs, the patient has severe chest pain, then vomits pus, the amount of pus is a lot, sometimes up to hundreds of ml, the patient has difficulty breathing, restlessness, anxiety, sweating, fatigue. . When oozing pus, prevent pus from overflowing into the airways, causing asphyxiation. After a few hours, the patient stabilized, the symptoms decreased. After oozing pus, the patient's condition improved, coughing, chest pain, fever, eating, sleeping, but still continued to spit out pus.
Stage of abscess with the bronchi. Patients often have strong, tired, persistent coughs, expectoration of purulent sputum. Sputum is green, viscous, homogeneous. There are many large round hat-shaped spots on the face, often a little foam on the top. Sometimes there are even streaks of blood.
At the beginning of spitting up pus, the patient's condition temporarily improved, but at this stage, the patient's condition gradually deteriorated, thin, pale, white blood cell count and polymorphonuclear leukocyte percentage increased.
Depending on the location of the lung abscess, each patient will have an easier position to spit out pus. These are the drainage positions of the lung abscess. The patient's temperature is very erratic, when the patient is well drained, the body temperature decreases, when the pus is stagnant, the body temperature increases.
If the case of purulent fossa is in the periphery and does not communicate with the bronchi, the patient has no symptoms of emphysema. In these patients, the lung abscess is very easy to rupture into the pleura causing emphysema. This is a dangerous complication with a high mortality rate.

Lung abscess is usually treated medically with antibiotics with the principle of combining 2 or more antibiotics for at least 4 weeks, using high doses from the beginning, using drugs after obtaining microbiological specimens. and change antibiotics according to clinical course or antibiogram.
In addition, surgical methods of abscess drainage are used in conjunction with drug therapy. Types of drainage are performed as follows:
Based on straight, inclined chest X-ray film or chest computed tomography image to choose the appropriate drainage position, thoracic defibrillation for the patient. Drain, vibrate several times a day to get the most out of the pus. Use flexible bronchoscopy to drain pus from abscesses. Flexible bronchoscopy also helps detect lesions causing bronchial obstruction and remove foreign bodies if present. Method of drainage of lung abscess through the chest wall is as follows: The patient is anesthetized or local anesthetic. The doctor will make a short incision in the intercostal space, under local anesthetic, in layers, near the pleural wall. After a few days, an adhesion will form between the parietal and visceral leaves, this is an isolated site from the pleural space, drainage will be performed through this location to avoid pus regurgitation into the pleural space. If there is no adhesion, the parietal leaf must be sutured to the visceral leaf, well covered with gauze before making an incision in the lung abscess. Place drainage of the pleural cavity for several days to prevent empyema.
After 10-30 days, the abscess will shrink, proceed to withdraw the drain. In some cases, the abscess remains a small, pus-free, thick crust, but no surgery is needed.
If medical treatment and drainage are unsuccessful, the abscess is >10cm, the patient is hemoptysis with recurrent or life-threatening hemoptysis, the abscess is associated with severe focal bronchiectasis or disease patients with complications of bronchopleural leak. The patient may be indicated for lung abscess surgery.
In lung abscess surgery, the patient will be surgically removed a lobe, a lobe or a whole lung, depending on the extent of spread and the patient's condition with respiratory function within the allowable limit (FEV1> 1 liter compared to theory).

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