PURPOSE: Recently, thoracoscopic intervention for management of pleural empyema and complicated pleural effusion is widely used. This study was aimed to compare the clinical results of video-assisted thoracoscopic intervention with conventional thoracotomy decortication, and investigate which factor determine the tools of management of pleural empyema and complicated pleural effusion.
METHODS: From January 2002 to May 2006, 23 patients were enrolled. We compared the length of hospitalization, the duration and amounts of pleural drainage and operation time of two procedures. And we investigate the results of pleural fluid analysis and radiologic examinations.
RESULTS: Thoracotomy were 12 (including 3 conversions) and thoracoscopy were 11. Mean age was 19.7 years old. Mean length of hospitalization were 23 days, in thoracotomy 20 days and in thoracsocopy 26 days (p=.53) Mean duration of chest tube were 11.6 days, in thoracotomy 9.9 days and in thoracoscopy 13.7 days. (p=.54) Mean drainage of chest tube were 1699cc, in thoracotomy 2026cc and in thoracoscopy 1306cc. (p=.40) Operation time was mean 196 minutes, in thoracotomy 259 minutes and in thoracoscopy 128 minutes(p=.03).At discharge, all patients showed symptoms improvement, decreased pleural effusion, loculation and good lung re-expansion. There was no operative mortality, but there were 7 morbidities, thoracotomy 4 (Wound problem 3, persistent pleural drainage 1) and thoracoscopy 3 (persistent pleural drainage). Presumed etiologies were tuberculosis 14 and bacterial parapneumonic effusion 9. In pleural fluid analysis, there were no significant differences between two groups. Loculation in chest CT was more severe in thoracotomy group, on the other hand, less loculation were found in thoracoscopy (p=.02). And pleural thickening in chest CT showed a tendency that less thickening was found in thoracoscopic decortication (p=.06).
CONCLUSION: Thoracoscopic intervention is safe and effective management of pleural empyema and complicated effusion. In the patients who had less loculation and pleural thickening in CT, thoracoscopic intervention is more appropriate.
CLINICAL IMPLICATIONS: We can suggest the selection criteria of thoracoscopic intervention for the management of pleural empyema and complicated pleural effsion.
DISCLOSURE: Eun Hwang, No Financial Disclosure Information; No Product/Research Disclosure Information