Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ² test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ²=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ²=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ²=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.
Female ; Male ; Humans ; Empyema, Tuberculous/surgery* ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Drainage ; Blood Loss, Surgical ; Tuberculosis, Multidrug-Resistant/surgery*

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.
Male ; Female ; Humans ; Abscess/complications* ; Empyema, Pleural/etiology* ; Empyema, Tuberculous/complications* ; Retrospective Studies ; Thoracic Wall ; Debridement/adverse effects* ; China ; Chest Tubes/adverse effects* ; Tuberculosis/complications* ; Thoracic Surgery, Video-Assisted ; Drainage

Objective: To examine the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) decortication in patients presenting with stage Ⅲ tuberculous empyema. Methods: From August 2017 to July 2020, 158 patients of stage Ⅲ tuberculous empyema underwent uniportal VATS decortication with partial rib resection and customized periosteal stripper in Department of Thoracic Surgery, Shanghai Pulmonary Hospital. There were 127 males and 31 females, aged (M(IQR)) 32(28) years (range:14 to 78 years). Follow-up was performed in the outpatient clinic or via social communication applications, at monthly thereafter. If there was no air leak and chest tube drainage was less than 50 ml/day, a chest CT was performed. If the lung was fully re-expanded, chest tubes were removed. All patients received a follow-up chest CT 3 to 6 months following their initial operations which was compared to their preoperative imaging. Results: There was one conversion to open thoracotomy. The operative time was 2.75 (2.50) hours (range: 1.5 to 7.0 hours), and median blood loss was 100 (500) ml (range: 50 to 2 000 ml). There were no perioperative mortalities. There were no major complications except 1 case of redo-VATS for hemostasis due to excessive drainage and 1 case of incision infection, The incidence of prolonged air leaks (>5 days) was 80.3%(126/157). The postoperative hospital stay was 5.00 (2.25) days (range: 2 to 15 days). All patients were discharged with 2 chest tubes, and the median duration drainage was 21.00 (22.50) days (range: 3 to 77 days). Follow-up was completed in all patients over a duration of 20 (14) months (range: 12 to 44 months). At follow-up, 149 patients(94.9%) recovered to grade Ⅰ level, 7 patients to grade Ⅱ level, and 1 patient to grade Ⅲ level. Conclusion: Uniportal VATS decortication involving partial rib resection and a customized periosteal stripper is safe and effective for patients with stage Ⅲ tuberculous empyema.
Aged ; China ; Empyema, Tuberculous/surgery* ; Female ; Humans ; Male ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy

OBJECTIVETo study the experiences and operative procedure choice for surgical management of chronic tuberculous empyema.

METHODSTotally 461 patients of chronic tuberculous empyema were treated surgically in Shandong Provincial Chest Hospital between January 2006 and December 2011. There were 317 male and 144 female patients, aging from 6 to 79 years with a mean age of 32 years. Preoperative duration lasted from 3 months to 50 years, including 347 cases within 1 year, 61 cases 1 to 2 years, and 53 cases above 2 years. Chest tube drainage or pleuracentesis was performed in 395 patients, decortication in 287 patients, thoracoplasty in 13 patients, pleuropneumonectomy and resection of remaining lung in 11 patients, complex operation in 150 patients.

RESULTSThere was no death perioperatively. Four hundred and forty-five patients were cured at once, 6 patients were cured by stages. One patient with empyema and bronchial fistula relapsed bronchial fistula after pulmonary lobectomy and pleural decortication, whom was cured by the combination operation which including fistula repair, muscle flap tamponing and local thoracoplasty according to the closed drainage of thoracic cavity after 6 months. Three cases were suffered incision delayed healing and were cured by dressing change. Five cases were suffered abscess of chest wall within 3 months and were cured by local thoracoplasty. One patient died due to respiratory failure in one year which resulted in tuberculosis spreading because of bronchial fistula after pleuropneumonectomy.

CONCLUSIONSSurgical management of chronic tuberculous empyema still have irreplaceable roles. Selecting appropriate operations according to different cases will achieve good results.

Abscess ; Adolescent ; Adult ; Aged ; Bronchial Fistula ; Chest Tubes ; Child ; Chronic Disease ; Drainage ; Empyema, Tuberculous ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pneumonectomy ; Respiratory Insufficiency ; Surgical Wound Infection ; Thoracic Wall ; Thoracoplasty ; Young Adult

Chronic empyema thoracis results from various etiologies. Improvement in pulmonary function after empyemectomy and decortication has proved difficult to predict when the etiology of chronic empyema thoracis is tuberculosis. The purpose of this study was to confirm the changes in pulmonary function according to the etiology after an operation. Sixty-five patients were classified into two groups according to their etiology: Group A (tuberculous) and Group B (non-tuberculous), and they were retrospectively evaluated with regard to their forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), percentage of predicted normal value of FEV1 (% FEV1) and FVC (%FVC). Empyemectomy and decortication was performed for all the patients and the two groups were similar in age, gender and preoperative spirometric parameters. In Group A (n=41), the pre- and postoperative mean values were 2.31L and 2.88L in FEV1, 65.8% and 80.5% in %FEV1, 2.62L and 2.55 L in VC, 61.9% and 71.8% in %VC, respectively. In Group B (n=24), the pre- and postoperative mean values were 2.13L and 2.49L in FEV1, 66.4% and 73.8% in %FEV1, 2.55L and 2.95 L in FVC, 64.9% and 71.8% in %FVC, respectively. All the spirometric parameters improved significantly in both groups compared to their preoperative values. However, no significance was shown in the rate of increase of the spirometric parameters between the two groups. In conclusion, improvement of lung function is expected after empyemectomy and decortication, regardless of the etiology of the chronic empyema thoracis.
Adult ; Chronic Disease ; Comparative Study ; Debridement ; Empyema, Pleural/physiopathology/surgery ; Empyema, Tuberculous/*physiopathology/*surgery ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Vital Capacity

Reconstruction of chest wall defects has been a continuing challenge to surgeons. Defects due to resection of tumors, infection, radiation injuries, and congenital anomalies may require chest wall reconstruction. Recent advances in plastic surgery have made reconstruction of the chest wall a reliable procedure. We reviewed fourteen consecutive chest wall reconstructions except mediastinitis over the past eight years. Among the patients, ten patients had chest wall tumors and remaining four patients had radiation necrosis, pressure sore, Poland's syndrome and Tuberculous empyema. Skeletal resection of the chest wall was done in six patients; Total or partial stemectomies were performed in three patients and an average of three point six ribs were resected in six patients. Soft tissue resection was performed in twelve patients. After resection, the thoracic skeletal defect was reconstructed with polypropylene mesh (Marlex) alone in one patient, with a composite of polypropylene mesh (Marlex) and methyl metacrylate in two patients, and with autogenous ribs in one patient. Soft tissue reconstructive procedures were predominantly muscle transpositions: five pectoralis major, three latissimus dorsi,two rectus abdominis and three fasciocutaneous flaps. Eleven patients who were alive after operation have protective and functional chest wall with excellent cosmesis at the time of last follow-up. We conclude that chest wall reconstructive procedures with prosthetic, or autogenous materials and musculocutaneous flaps are safe, durable and contributive to long-term survival and quality of life.
Empyema, Tuberculous ; Follow-Up Studies ; Humans ; Mediastinitis ; Myocutaneous Flap ; Necrosis ; Polypropylenes ; Pressure Ulcer ; Quality of Life ; Radiation Injuries ; Rectus Abdominis ; Ribs ; Surgery, Plastic ; Thoracic Wall* ; Thorax*