Abstract:

Objective To explore the feasibility of procedure-optimized complete video-assisted thoracoscopic surgery in the treatment of chronic tuberculous empyema.Methods We collected 59 patients with chronic tuberculous empyema who underwent video-assisted thoracoscopic surgery in the Fourth Hospital of Chaoyang City from April 2015 to August 2017, the clinical data of chronic tuberculous empyema removal and stripping of pleural fibrous plate in this group of patients was analyzed and the clinical efficacy was evaluated, and focused on the method and effect of “ procedure optimization” surgery. The procedure optimization surgical method is a new method designed by the author to overcome the technical difficulties in the treatment of chronic tuberculous empyema by video-assisted thoracoscopic surgery through clinical practice. Procedure optimization surgical method mainly includes the following aspects: changing the order of thoracoscopic incision layout, improving the technology of thoracoscopic operation space, unifying the sequence of stripping of pleural fibrous plate, and the unique placement method of thoracic drainage tube.Results All the 59 patients underwent video-assisted thoracoscopic surgery successfully. The duration of surgery was 60-180min, average (median (quartile), M(Q₁,Q₃)) 110 (90,140)min, and intraoperative hemorrhage was 150-2000ml, average (M(Q₁,Q₃)) 700 (550,800)ml. Catheter retention time was 4 to 22d, average (M(Q₁,Q₃)) 7 (5,10)days. Post-operative hospitalization time was 6 to 24days, average (M(Q₁,Q₃)) 9 (7,12)days. The incidence of postoperative complications was 23.3% (14/60), including 5 cases of delayed wound healing, 5 cases of continuous lung leakage and 1 case of chylothorax. Chronic sinus tract was formed in 3 patients with incision re-infected and was healed after the proper treatment of incision. Postoperative follow-up lasted 3-36months,average (M(Q₁,Q₃)) 16 (8,22)months, and there was no recurrence of empyema.Conclusion The method of procedure optimization for the treatment of chronic tuberculous empyema by complete video-assisted thoracoscopic surgery is effective, safe and reliable.

Key words: Thoracic surgery, video-assisted, Empyema, tuberculous, Chronic disease, Surgical procedures, minimally invasive, Treatment outcome