Abstract:

Objective To discuss surgical treatments for chronic massive tuberculous empyema.Methods From 2015 to 2017 in Shenyang Chest Hospital, 36 patients who underwent surgical resection, were pathologically confirmed as tuberculous empyema after surgery, and had empyema occupying more than 50% of the thoracic cavity of the affected side (indicated by preoperative chest X-ray) were included in this study, including 20 patients with large encapsulated empyema and 16 patients with total empyema. The therapeutic effects of pleural fiberboard decortication, pleural pneumonectomy and thoracoplasty for different patients were analyzed.Results All 36 patients underwent complete resection of the lesions. Twenty-six patients underwent pleural fiberboard decortication, including 20 cases of large encapsulated empyema and six cases of total empyema. In 10 patients with large encapsulated empyema, the fiberboard on parietal pleura were not removed, as the lung was poorly re-expanded and there was a small residual cavity after decortication of the fiberboard on visceral pleura. After closed drainage for 2 to 8 weeks combined with negative pressure suction, the lung of these patients were well re-expanded and the residual cavity disappeared. Thus they were cured and discharged. Seven patients with total empyema complicated with lung destruction underwent pleural pneumonectomy. Among them, two patients received pleural fiberboard decortication and total pneumonectomy, as the lung could not expand at all; and five patients received pleural fiberboard decortication and pulmonary lobectomy, as severe intralobar tuberculosis was found in single pulmonary lobe but another pulmonary lobe showed mild pleural rupture and was well expanded. These patients were clinically cured after receiving mechanical ventilation for one to three days and standardized anti-tuberculosis drugs for six to nine months. Three patients with total empyema underwent thoracoplasty. Among them, one patient complicated with bronchial pleural fistula directly received thoracoplasty; and the other two patients received pleural fiberboard decortication and localized thoracoplasty, as intrapulmonary tuberculosis lesions were stable in these cases and the lung was poorly re-expanded and a large residual cavity was left even after removing the fiberboard on visceral pleura and retaining the fiberboard on parietal pleura. They underwent compression dressing and was cured and discharged three weeks later. Of the 26 patients who underwent pleural fiberboard decortication, internal bleeding occurred in one patients. Of the seven patients who underwent pleural pneumonectomy, one experienced acute respiratory failure. Of the three patients who underwent thoracoplasty, one had poor wound healing.Conclusion Pleural fiberboard decortication is the first choice for tuberculous empyema. On the basis of strict adherence of surgical indications, the three surgical procedures are safe and effective.

Key words: Empyema, tuberculous, Chronic disease, Surgical procedures, elective, Treatment outcome