Despite advances in surgical techniques and supportive therapy, chronic empyema is still associated with considerable morbidity and mortality. The purpose of this study was to evaluate the efficacy of surgical procedures.
Thirty-seven patients with chronic tuberculous empyema were studied. Twenty cases had bronchopleural fistula. All patients were studied for more than three years. Mortality rates and recurrence rates were evaluated.
Among 17 cases without bronchopleural fistula, 10 were treated with decortication. Lung resection was necessary in two cases. Extrapleural pneumonectomy was performed in two cases, and thoracoplasty in three cases. Other procedures included one muscle flap closure, and two open drainages. The mortality rate was 0% and the recurrence rate was 5.9%.Among the 20 cases with bronchopleural fistula, nine were initially treated with open drainage. In the second stage operation, one case was treated with extrapleural pneumonectomy, but died from cardio-respiratory failure. Extrapleural pneumonectomy combined with thoracoplasty (EPTP) was successfully performed in two cases, and thoracoplasty in four cases (two with omentopexy). One case was treated with a muscle flap closure. There was no recurrence, but the mortality rate was 11.1%. The other 11 cases with fistula were treated with a single-stage operation. Extrapleural pneumonectomy was performed in four cases, thoracoplasty in 5 cases, and a muscle flap closure with omentopexy was performed in one case. The result was two deaths and two recurrences. Recently, EPTP by anterior approach was successfully performed in one case with a severely damaged lung in spite of a poor general condition. The mortality rate of the single-stage operation was 18.2% and the recurrence rate was 18.2%. All the cases with recurrence were successfully treated with additional surgical operations. Overall efficacy of the surgical treatment was 86.5% (32/35).
Surgical treatment was a effective method for the treatment of tuberculous empyema.
Chronic tuberculous empyema is a difficult disease to cure. The result of the surgical treatment was much effectibe than that of medical treatment.
Masanori Kaneda, None.