Thoracoscopic intervention for management of pleural empyema and complicated effusion is widely used. This study was aimed to compare the clinical results of thoracoscopic intervention with conventional thoracotomy decortication, and investigate which factor determine the tools of management of pleural empyema and complicated effusion.
From January 2002 to March 2008, 25 patients were enrolled. We compared the clinical data (duration of pleural drainage, operation time of two procedures, and postoperative morbidity). And we investigate the results of pleural fluid analysis and radiologic examinations and analyze the data statistically for determining parameters of the tools of management.
Thoracotomy were 14 (including 3 conversions) and thoracoscopy were 11. Male/Female was 20/5. Mean age was 40.5 years old. Mean duration of chest tube were 11.7 days, in thoracotomy 10.3 days and in thoracoscopy 13.7 days. (p = .50) Operation time was mean 200 minutes, in thoracotomy 256 and in thoracoscopy 128 minutes (p = .001). Presumed etiologies were tuberculosis 15 and bacterial parapneumonic effusion 10. At discharge, all patients showed symptoms improvement, decreased pleural effusion or loculation and good lung reexpansion on Chest X-ray. There was no operative mortality, but there were 9 morbidities, thoracotomy 6 (Wound problem 4, persistent pleural drainage over 14days 2 ) and thoracoscopy 3 (3 persistent pleural drainage over 14days). Radiologic examinations didn’t show any significant factors to determine the tools between thoracotomy and thoracoscopy. But in pleural fluid analysis, glucose concentration was significantly lower in thoracotomy (mean 42.4mg/dl) than that of thoracoscopy (mean 103.3mg/dl) (p = .002) And, we could find cut-off value (74.5mg/dl) by ROC curve (sensitivity 87.5%, specificity 90%).
Thoracoscopic intervention is safe and effective management of pleural empyema and complicated effusion. And, in pleural fluid analysis, glucose concentration can be a useful parameter to determine the use of thoracoscopy to manage empyema and complicated effusions.
Pleural fluid analysis is important to determine the tools of management of pleural empyema and complicated effusions especially glucose level.
Eun-Gu Hwang, No Financial Disclosure Information; No Product/Research Disclosure Information