Abstract:

Objective This study aimed to investigate the efficacy and safety of video-assisted thoracoscopic surgery (VATS) in the treatment of chronic tubercular empyema. Methods The clinical data of 82 patients with chronic tuberculous empyema treated in the Department of Thoracic Surgery, Xi’an Chest Hospital from January 2015 to December 2017 were retrospectively collected, including age, gender, course of disease, and lesions site. The patients were divided into VATS group (42 cases) and thoracotomy group (40 cases) according to the operation methods performed by the patients, and then the operation time, intraoperative blood loss, postoperative drainage volume, hospital stays, extubation time, complications, lung function recovery status (main indicators including forced vital capacity (FVC), 1st second forced expiratory volume in one second (FEV₁), total lung capacity (TLC)), and relapse after 2 years of follow-up were compared. Results The intraoperative blood loss ((284.70±40.47) ml) and postoperative drainage volume ((687.40±78.58) ml) in the VATS group were significantly lower than the thoracotomy group ((309.90±58.82) ml and (748.00±65.22) ml, respectively), with the statistically significant differences (t=2.27 and 3.79, P=0.03 and 0.00, respectively); there were no significant differences in the operation time ((130.54±14.95) min vs (135.30±13.09) min), hospital stays ((12.30±2.54) d vs (11.70±2.06) d) and extubation time ((6.80±1.32) d vs (6.56±1.03) d) between the VATS group and thoracotomy group (t=1.53, 1.17, 0.92, P=0.13, 0.25, 0.36, respectively). The postoperative lung function indexes, such as FVC ((3.41±0.64) L), FEV₁ ((3.45±0.56) L), and TLC ((5.82±0.87) L), in the VATS group were compared with the thoracotomy group ((3.26±0.89) L, (3.34±0.73) L, (5.78±0.35) L, respectively), and the differences were not statistically significant (t=0.79, 0.50, 0.26, P=0.43, 0.60, 0.81, respectively). The incidence of postoperative complications in the VATS group was 11.9% (5/42), which was significantly lower than 30.0% (12/40) in the thoracotomy group, with the statistically significant difference (χ²=4.08, P<0.05). After 2 years of follow-up, the recurrence rate in the thoracotomy group was 5.0% (2/40), while no recurrence was found in the VATS group, with no statistically significant difference between the two groups (χ²=2.15, P=0.14). Conclusion The patients with chronic tuberculous empyema underwent VATS show low intraoperative blood loss, postoperative drainage and postoperative complications, which is worthy of clinical application.

Key words: Empyema, tuberculous, Thoracoscopy, Treatment outcome, Evaluation studies