Analysis of diagnosis and treatment of 76 cases of chronic tuberculous empyema treated by complete thoracoscopy with process optimization method

doi:10.19983/j.issn.2096-8493.20230063

Abstract

Abstract:

Objective: To explore the feasibility of the process optimization method in the treatment of chronic tuberculous empyema under complete thoracoscopy. Methods: The data of 76 patients with chronic tuberculous empyema who underwent complete thoracoscopic surgery with procedure optimization method in the Fourth Hospital in Chaoyang City from April 2015 to February 2019 were retrospectively analyzed. The process optimization methods mainly include changing the incision design sequence of thoracoscopic surgery, improving the technology of thoracoscopic operation space establishment, unifying the sequence of fiberboard stripping, and unique thoracic drainage tube placement. The evaluation time of long-term efficacy was based on the time of 9-12 months of standardized anti-tuberculosis drug treatment after surgery. Results: Video-assisted thoracoscopic surgery was successfully completed in all 76 patients, and a total of 77 surgeries were performed, among which 1 patient with bilateral chronic tuberculous empyema underwent staging surgery without conversion to thoracotomy. The operation lasted 60 to 260 minutes, with the median of 120 (90, 160) minutes, and the intraoperative bleeding was 150 to 2000 ml, with the median of 700 (540, 800) ml. Drainage tube indwelling time was 4-22 days (median, 7 (6, 11) days). Postoperative hospitalization lasted 6 to 26 days (median, 8 (7, 13) days). The incidence of postoperative complications was 19.5% (15/77), including delayed incision healing in 6 cases, persistent lung leakage in 8 cases and chylothorax in 1 case. Postoperative follow-up was 9 to 55 months (median, 26 (20, 37) months), no cases recurrence or underwent second operation. The long-term outcome was evaluated: 88.2% (67/76) achieved grade Ⅰ, 9.2% (7/76) achieved grade Ⅱ, and 2.6% (2/76) achieved grade Ⅲ. Conclusion: The long-term effect of complete video-assisted thoracoscopic surgery used to treat chronic tuberculous empyema by process optimization method is good. For patients with surgical indications, it is worth promoting.

Key words: Thoracic surgery, video-assisted, Empyema, tuberculous, Surgical procedures, minimally invasive, Treatment outcome

CLC Number:

Zhang Ying, Lao Haijun, Lin Bing, Liu Junting, Sun Dongmei. Analysis of diagnosis and treatment of 76 cases of chronic tuberculous empyema treated by complete thoracoscopy with process optimization method[J]. Journal of Tuberculosis and Lung Disease , 2023, 4(4): 308-312. doi: 10.19983/j.issn.2096-8493.20230063

References 6

[1]	王钧, 吴万鹏, 孙顺兴, 等. 电视胸腔镜在结核性脓胸治疗中的应用. 天津医药, 2010, 38(12): 1097-1099. doi:10.3969/j.issn.0253-9896.2010.12.028. doi: 10.3969/j.issn.0253-9896.2010.12.028
[2]	张运曾, 金锋, 王成. 电视辅助胸腔镜手术在结核性脓胸治疗中的应用及进展. 中国防痨杂志, 2017, 39(5): 525-528. doi:10.3969/j.issn.1000-6621.2017.05.021. doi: 10.3969/j.issn.1000-6621.2017.05.021
[3]	王成, 金锋. 胸腔镜辅助小切口在慢性包裹性结核性脓胸手术中的应用. 中国防痨杂志, 2018, 40(12): 1267-1270. doi:10.3969/j.issn.1000-6621.2018.12.005. doi: 10.3969/j.issn.1000-6621.2018.12.005
[4]	周逸鸣, 洪旗, 尹桂东, 等. 单孔胸腔镜全纤维板剥脱术治疗Ⅲ期结核性脓胸158例临床分析. 中华外科杂志, 2022, 60(1):90-94. doi:10.3760/cma.j.cn112139-202100829-00398. doi: 10.3760/cma.j.cn112139-202100829-00398
[5]	张瑛, 白舒, 丁国强. 电视胸腔镜手术治疗慢性脓胸12例. 中国微创外科杂志, 2008, 8(7):616-617. doi:10.3969/j.issn.1009-6604.2008.07.017. doi: 10.3969/j.issn.1009-6604.2008.07.017
[6]	张瑛, 朱文, 刘俊婷, 等. 流程优化完全电视胸腔镜手术治疗慢性结核性脓胸(附59例报告). 中国防痨杂志, 2018, 40(12):1262-1266. doi:10.3969/j.issn.1000-6621.2018.12.004. doi: 10.3969/j.issn.1000-6621.2018.12.004

[1]	Zhou Lin, Liu Eryong, Zhao Yanlin. Select appropriate treatment plan and correctly evaluate the efficacy of anti-tuberculosis treatment, improving the treatment quality of rifampicin sensitive tuberculosis [J]. Journal of Tuberculosis and Lung Disease, 2023, 4(3): 189-193.
[2]	Yang Chao, Wang Jing, Xie Ke, Tang Guilin, Gao Hanqing, Wang Bin. Analysis of the epidemiological characteristics and treatment outcomes of pulmonary tuberculosis with positive etiology in Tongzhou, Beijing from 2012 to 2021 [J]. Journal of Tuberculosis and Lung Disease, 2023, 4(2): 128-134.
[3]	Zhang Yajing, Jiang Ying, Sun Hao, Tang Guiqin, Zhao Ying. Analysis of detection and treatment prognosis of 154 elderly pulmonary tuberculosis patients [J]. Journal of Tuberculosis and Lung Disease, 2023, 4(1): 48-53.
[4]	Guo Qiang, Li Ruiping, Ma Yubao, Zhang Lan, Yang Shumin. Analysis of treatment adverse outcomes for rifampicin sensitive pulmonary tuberculosis patients with random effects logistic model in Gansu Province from 2018 to 2020 [J]. Journal of Tuberculosis and Lung Disease, 2022, 3(6): 455-462.
[5]	Huang Yao, Fan Yuzheng, Wang Xiangyu, Zhong Tao, Zhang Jie, Yang Nansen, Li Shengbin, Ye Xuetian, Liu Shengyuan. Analysis of management and treatment effects of pulmonary tuberculosis patients in Nanshan District, Shenzhen City, 2011—2020 [J]. Journal of Tuberculosis and Lung Disease, 2022, 3(6): 463-468.
[6]	Chen Zidan, Mao Ling. Clinical analysis of 28 cases of artificial stone associated silicosis complicated with pulmonary tuberculosis and non-tuberculous mycobacteria disease [J]. Journal of Tuberculosis and Lung Disease, 2022, 3(5): 388-393.
[7]	Dong Zhaoliang, Yao Liming, Li Lingdi, Wang Lianbo, Yao Xiaowei, Li Zhuo, Liu Fengsheng, Jia Chenguang. Clinical efficacy of conservative treatment for mild spinal tuberculosis [J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 281-286.
[8]	Li Yishuai, Qin Xuebo, Li Xianglan, Wei Lan, Duan Xiaoliang, Zhang Lei, Chen Liang, Li Jianhang. Analysis of effect of video-assisted thoracoscopic surgery versus thoracotomy in the treatment of refractory cavity pulmonary tuberculosis [J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 292-295.
[9]	WEI Jian-hua, GUO Tao, GAO Xiao-na, WU Wei, GUO Lei. Clinical characteristics and treatment outcome of 151 hospitalized students with tuberculosis [J]. Journal of Tuberculosis and Lung Disease, 2021, 2(4): 330-335.
[10]	LIAO Xiao-qin, LIN Jian-dong, WU Di, CHEN Xiao-hong. Analysis of the clinical characteristics of Mycobacterium avian complex pulmonary disease and the risk factors of treatment effect [J]. Journal of Tuberculosis and Lung Disease, 2021, 2(2): 120-124.
[11]	ZHANG Hong-wei, SUN Shan-hua, GAO Zhi-dong, XU Yan, TAO Li-ying, CHEN Xi. Treatment and outcomes of rifampicin-resistant pulmonary tuberculosis in Beijing, 2016—2020 [J]. Journal of Tuberculosis and Lung Disease, 2021, 2(2): 164-168.
[12]	GUO Qian, SHEN Chen. The progress of non-tuberculous mycobacterium disease in children [J]. Journal of Tuberculosis and Lung Disease, 2021, 2(2): 184-188.
[13]	XIAO Juan, PI Hong-lin, SUN Qing-peng. Analysis of clinical characteristics and therapeutic effect of 96 patients with spinal tuberculosis underwent surgical treatment [J]. Journal of Tuberculosis and Lung Disease, 2021, 2(1): 38-42.
[14]	HUANG Jin-bao, LAN Chang-qing, LYU Xiao, CHEN Lu-lu, WANG Xin-hang, CHEN Yu-rong, HUANG Ming-xiang. Analysis of 23 cases of imported coronavirus disease 2019 [J]. Journal of Tuberculosis and Lung Disease, 2020, 1(3): 213-219.
[15]	JIN Min-lu, CHANG Yun-qing, QI Feng-ming, GUAN Xiao-gang, ZHENG Guan-hua, ZHAO Yong-hua, LI Zhen-qiang, LI Xiao-sheng, WANG Li-fen, WANG Fang, BAI Yin-jie. Clinical characteristics and effect analysis of 39 cases of 2019 novel Coronavirus-related pneumonia [J]. Journal of Tuberculosis and Lung Disease, 2020, 1(2): 131-135.