Abstract:

Objective To explore the clinical characteristics and the outcome of surgical treatment of empyema necessitatis, the complication of tuberculous empyema.Methods The data of 192 patients with cellulosic empyema (Stage Ⅱ) and organic empyema (Stage Ⅲ) who underwent surgery in Shandong Chest Hospital between January 2008 and December 2016 were retrospectively analyzed. Among them, 90 cases who occurred empyema necessitatis were set as observation group, and 102 patients who did not occur empyema necessitatis were set as control group. The clinical features, surgical effects and complications of the two groups were compared.Results The proportion of females, previous history of tuberculous pleurisy, preoperative thoracic catheterization, preoperative thoracic biopsy, and localized empyema in the observation group were 36.67% (33/90), 23.33% (21/90), 47.78% (43/90), 15.56% (14/90), and 96.67% (87/90), respectively, which were significantly higher than those in the control group (19.61% (20/102), 11.76% (12/102), 14.71% (15/102), 4.90% (5/102), and 78.43% (80/102)); the differences were all statistically significant (χ ² values were 6.96, 4.50, 24.80, 6.09, and 14.04; P values were 0.008, 0.034, <0.001, 0.014, and <0.001, respectively). In the observation group, the median (quartile) (M(Q₁,Q₃)) of the operation time and intraoperative blood loss were 3.50 (3.00, 4.50)h and 300.00 (200.00, 500.00)ml, respectively, which were significantly lower than those in the control group (4.00 (3.50, 5.00)h and 600.00 (400.00, 675.00)ml); the differences were statistically significant (U values were 5639.00 and 6692.00; P values were 0.006 and <0.001). In the observation group, 62 cases (68.89%, 62/90) removed the ribs, M(Q₁,Q₃)) of the postoperative drainage tube time and hospital stay were 10.00 (8.00, 13.00)d and 18.00 (15.00, 18.75)d, and 11 patients (12.22%, 11/90) had complications after operation, which were significantly higher than those in the control group (17 cases (16.67%, 17/102), 8.00 (7.00, 10.00)d, 16.00 (15.00, 18.00)d, and 4cases (3.92%, 4/102); the differences were statistically significant (χ ²=53.84, U=3065.00, U=3630.00, and χ ²=4.57; P values were <0.001, <0.001, 0.012, and 0.032). Conclusion Occurrence of empye-ma necessitatis in patients with tuberculous empyema could increase surgical trauma, duration of postoperative drainage tube, length of hospital stay, and the incidence of postoperative chest wall tuberculosis.

Key words: Empyema, tuberculous, Thoracic surgical procedures, Treatment outcome, Complications