Abstract:

Objective: To explore the risk factors of uniportal video-assisted thoracoscopic surgery (VATS) to small incision or standard thoracotomy for Stage Ⅲ tuberculous empyema for pulmonary decortication. Methods: A total of 232 patients diagnosed and treated with VATS for pulmonary decortication in Xi’an Chest Hospital from January 2018 to February 2023 were enrolled. Among them, 158 patients underwent uniportal thoracoscopic pulmonary decortication (thoracoscopic group), 74 patients were converted from thoracoscopic surgery to small incision or standard thoracotomy during surgical (conversion to thoracotomy group). The influencing factors of the occurrence of conversion to small incision or standard thoracotomy during surgery were analyzed using univariate analysis and multivariate logistic regression. Results: In the thoracoscopic group, extensive peripheral lung lesions were found in 7.0% (11/158) of patients and concomitant chronic lung disease was found in 13.3% (21/158) of patients with preoperative CT, which were significantly lower than those in the conversion to thoracotomy group (48.6% (36/74), χ²=54.213, P<0.001; 43.2% (32/74), χ²=25.651, P<0.001). Multivariate logistic regression results showed that peripheral pulmonary tuberculosis at the operative side (OR=26.595, 95%CI: 9.120-77.559) and complicated with chronic lung disease (OR=6.815, 95%CI: 2.977-15.601) were risk factors for the conversion to small incision or standard thoracotomy. Conclusion: Patients with peripheral lung disease and chronic lung disease on the operative side may fail to complete the operation through thoracoscopy due to pulmonary contusion or massive bleeding, and then convert to small incision or standard open chest operation under direct vision. The above factors could be considered as the focus factors for preoperative selection of operation methods.

Key words: Empyema, tuberculous, Thoracoscopes, Thoracic surgical procedures, Factor analysis, statistical