[Efficacy of video-assisted thoracoscopic surgical decortication for stage â ¢ tuberculous empyema].

Objective: To investigate the clinical efficacy, safety and feasibility of "double-portal" video-assisted thoracoscopic surgical(VATS) decortication among patients with stage Ⅲ tuberculous empyema, and then to evaluate the recovery of chest deformity. Method: This study was a single center retrospective study. A total of 49 patients with stage Ⅲ tuberculous empyema who underwent VATS pleural decortication at the Department of Thoracic Surgery, Public Health Clinical Center of Chengdu between June 2017 and April 2021 were enrolled, including 38 males, and 11 females, aged 13-60 (27.5±10.4) years. The safety and feasibility of VATS were further evaluated. The inner circumference of the chest on sternal and xiphoid planes on chest CT scans before and 1, 3, 6, 12months after decortication were collected through the measuring software of the CT. The samples in-pair test was used to compare the changes in the chest to reflect the recovery of the chest deformity. Results: In the 49 patients, The surgical time was (186±61) min, and the volume of blood loss was (366±267) ml. There were 8 cases (16.33%) with postoperative complications during the perioperative period. Constant air leak and pneumonia were the main postoperative complications. No relapse of empyema or dissemination of tuberculosis occured during the period of follow-up. Before surgery, the inner thoracic circumference of the thorax at the level of the carina plane was (655±54) mm, and the inner thoracic circumference of the thorax at the level of the xiphoid plane was (720±69) mm. Patients were followed for 12-36 months. The inner thoracic circumference of the thoracic cavity at the level of carina was (666±51), (667±47) and (671±47) mm at the 3rd, 6th and 12th months after operation, which were significantly larger than that at the level of carina before operation (all P<0.05). The inner thoracic circumference diameter of the thoracic cavity measured at the xiphoid level at the 3rd, 6th and 12th months after the operation was (730±65), (733±63) and (735±63) mm respectively(all P<0.05).The inner thoracic circumference of the thoracic cavity increased significantly than that before surgery (P<0.05). At 6 months after operation, there was significant difference in the improvement of the inner thoracic circumference of the carina plane in patients with age less than 20 years and FEV1% less than 80% (P=0.015, P=0.003). The improvement in the inner thoracic circumference of the carina plane in patients with pleural thickening≥8 mm compared with those with less than 8 mm was not statistically different(P=0.070). Conclusions: For some patients with stage Ⅲ tuberculous empyema, pleural decortication under thoracoscopy is safe and feasible, and can significantly restore the inner thoracic circumference of the patient's chest, improve the collapse of the patient's chest, and have significant clinical effect. The "double-portal VATS" surgical technology has the advantage of less trauma, wide operation field, large operation space and is easy to master, which is worth further exploring for clinical application.

[Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema].

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.

The efficacy and safety of uniportal video-assisted thoracic surgery on the treatment for stage II-III tuberculous empyema: a single-arm clinical retrospective study from 2016 to 2021 in a thoracic surgery center in China.

BACKGROUND: Surgery is an important adjuvant treatment for tuberculous empyema(TE). We thus conducted a single arm-clinical retrospective study of stage II-III TE patients who underwent uniportal video-assisted thoracic surgery (Uni-VATS) over a 5-year period to evaluate the efficacy and safety of surgery on TE, so as to provide the evidence for the optimal clinical strategies. METHODS: Patients diagnosed as TE with withdrawal of anti-tuberculosis-VATS were retrospectively enrolled from January 2016 to December 2021. All patients were followed up untill 12 months after withdrawal of anti-tuberculosis treatment (ATT). Clinical characteristics and surgical details were observed and analyzed to evaluate the efficacy and safety of the minimally invasive surgery. RESULTS: Totally 439 cases met included criteria were enrolled, no deaths were reported. The mean operative time was 2.6 (1.9, 4.3) hours and the mean intraoperative blood loss was 356 (240, 940) ml. Blood transfusion was performed in 20.50% (90/439) of patients and additional pneumonectomy was occurred in 9.89%(37/439)of patients .The mean postoperative drainage time was 12 (7, 49) days and the mean hospital stay was 6 (4,12) days. All stage II TE achieved complete lung re-expansion after surgery while 84.22%(315/374) of stage III achieved complete lung re-expansion, p 0.00. 15.78% (59/374) of stage III TE achieved incomplete re-expansion, 4 of which underwent a second decortication by Uni-VATS. Recurrences rate was 2.96% (13/439), including 11 cases of early recurrence and 2 cases of late recurrence at TE stage III, 5 of which underwent a second decortication by Uni-VATS. CONCLUSION: Uni-VATS is highly effective safe and minimally invasive for patients with TE, which could be recommended as the mainstream operation in areas with high TB burden.

[Uniportal thoracoscopic decortication for stage â ¢ tuberculous empyema of 158 cases].

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.

[Surgical treatment of tuberculous empyema in children]. / Khirurgicheskoe lechenie tuberkuleznoi émpiemy plevry u detei.

OBJECTIVE: To analyze surgical treatment of tuberculous pleural empyema in children depending on the stage of the process. MATERIAL AND METHODS: There were 82 patients aged 4-17 years with tuberculous pleural empyema. Clinical and X-ray features of different stages of disease are described. Certain types of surgical interventions at each stage of the process are analyzed. RESULTS: In 72 children with empyema stage III 76 surgeries were performed. Postoperative complications occurred in 2 (2.6%) cases (delayed lung inflation) that required thoracocentesis with pleural drainage. There was no postoperative mortality. CONCLUSION: Complex treatment of tuberculous pleural empyema in children and adolescents with the use of modern surgical methods is followed by satisfactory outcomes in all patients. However, surgical technique, postoperative morbidity and hospital-stay depend on the stage of the process. Unfortunately, almost 90% of patients had empyema stage III. Therefore, minimally invasive surgery was not advisable and extensive, traumatic surgeries were required.

[Interdisciplinary Treatment of Patients with Pulmonary Tuberculosis]. / Interdisziplinäre Therapie der Lungentuberkulose.

Today surgical procedures for pulmonary tuberculosis are highly selective but owing to the increasing incidence of multidrug resistant tuberculosis has been becoming more and more relevant. Besides the treatment of tuberculosis foci in multidrug resistance tuberculosis to eliminate the source of relapse, complications as sequelae of tuberculosis are among the most frequent indications for surgery. In patients with cavernous lesions, destroyed lobe or lung, bronchiectasis, pleural empyema or hemoptysis thoracic surgical procedures may be warranted. However, in solitary pulmonary nodules operations with diagnostic purpose are necessary, not only to rule out a potential malignancy, but also to identify a so far unidentified tuberculoma. Considering the heterogenous group of patients with tuberculosis, surgical morbidity and mortality are in the known range for surgical resections in lung cancer patients.

[Operative procedure choice for surgical management of chronic tuberculous empyema: a series of 461 cases].

OBJECTIVE: To study the experiences and operative procedure choice for surgical management of chronic tuberculous empyema. METHODS: Totally 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. RESULTS: There 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. CONCLUSIONS: Surgical management of chronic tuberculous empyema still have irreplaceable roles. Selecting appropriate operations according to different cases will achieve good results.

Intrathoracic muscular transposition in chronic tuberculous empyema.

BACKGROUND: The effective management of chronic tuberculous empyema requires an evacuation of pus and a re-expansion of the lung or an obliteration of the empyema space such as closed thoracostomy, decortication, or open window thoracostomy (OWT) followed by intrathoracic muscular transposition (IMT). However, the most effective management of chronic tuberculous empyema is still debatable. METHODS: From June 1999 to July 2010, 18 patients with chronic tuberculous empyema who underwent OWT and/or IMT were enrolled in this study. The causes of empyema, and methods and outcomes of treatment were retrospectively reviewed. The success rate of IMT was investigated to evaluate the efficacy. RESULTS: Mean patient age was 54.3 ± 14.9 years and 16 patients were male. Depending on operative methods, three groups were divided: OWT only (n = 4); two-stage operation as OWT followed by IMT (n = 7); and one-stage operation as OWT with IMT simultaneously (n = 7). Of 14 patients who underwent IMT, 13 patients successfully recovered from empyema and bronchopleural fistula (BPF) (success rate, 92.86%), but one patient developed a secondary bacterial infection. There was no operative mortality. CONCLUSION: This study suggests that IMT may be an effective option to control infection or BPF in chronic tuberculous empyema.

Evaluation of decortication in patients with chronic tuberculous empyema by three-dimensional computed tomography densitometry.

BACKGROUND: Decortication for chronic pleural empyema (CPE) is to restore lung volume by removing empyema sac and thickened pleura. Extent of lung volume restoration after decortication has been undefined. This study aims to evaluate lung volume restoration using densitometry with three-dimensional reconstruction computed tomography (CT). METHODS: We studied 23 patients with CPE who underwent decortication and follow-up CT. CT and pulmonary function test (PFT) were evaluated at a median of 19.1 months postoperatively. The volumes of operated and nonoperated lung were measured by pre- and postoperative CT-densitometry. Preoperative and postoperative values of lung volumes, PFTs, and thoracic asymmetry rates were compared statistically. RESULTS: The mean preoperative volumes of operated and nonoperated lung were 1,239 and 2,094 mL, respectively and 1,848 and 2,311 mL postoperatively. The postoperative lung expansion rate was 71% on the operated side (p < 0.001) and 15% on the nonoperated side (p = 0.026). The mean improvement rate of total lung volume was 31%. The postoperative value of forced vital capacity, forced expiratory volume during 1 second and lung diffusion capacity of carbon monoxide improved 28.0%, 27.4% (p < 0.001), and 17.9% (p < 0.012), respectively. The thoracic asymmetry decreased from 4.3% before surgery to 2.8% after surgery (p = 0.026). CONCLUSIONS: With the use of CT-densitometry, we quantified the changes of each lung volume. Decortication for CPE can improve re-expansion of diseased and healthy lung. Improvement of nonoperated lung may be due to the overall improvement of chest wall elasticity. Coincidentally, we discovered that the improvement of total lung volume was positively associated with the improvement of PFT after decortication.

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging.

To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.

A 2.5-cm single-port video-assisted thoracoscopic surgery for stage III tuberculous empyema: a case report.

BACKGROUND: Stage III tuberculous empyema is a common disease of tuberculosis. Traditionally, it has been treated by thoracotomy or video-assisted thoracoscopic surgery with two to four incisions. But conventional surgery has large trauma, large bleeding volume and long recovery time. To our knowledge it is the first report of surgery for stage III tuberculous empyema with a mini single-port approach. CASE PRESENTATION: A 23-year-old woman admitted to our hospital with complaints of intermittent chest pain for half a year. We got the diagnosis of stage III tuberculous empyema after medical treatment. Considering that the patient was young and unmarried, we decided to perform minimally invasive pleural decortication through a 2.5 cm single port. The operation time was 240 min, and blood loss was 100 ml. The patient recovered well and postoperative pain was mild. CONCLUSION: This case demonstrates that single-port VATS with a smaller incision for the Stage III tuberculous empyema should be considered in well selected patients.

[Video-assisted thoracoscopy in the diagnosis and surgical treatment of tuberculosis and other respiratory diseases].

Resection operations performed on the lung using endoscopic techniques are divided into VATS and video-assisted thoracoscopy. Our experience with VATS in patients with pulmonary tuberculosis and other respiratory disorders is 66 transactions. Complications in the postoperative period were not observed. The advantages of VATS in phtiziosurgical practice are high information content, reducing the time of diagnosis; reduction in the number of patients receiving test treatment, improve treatment quality and outcome of disease through early diagnosis verification, reducing economic losses due to refusal of the trial unreasonably prolonged courses of therapy for tuberculosis in the absence of radiographic dynamics.

A nomogram to predict residual cavity formation after thoracoscopic decortication in chronic tuberculous empyema.

OBJECTIVES: The goal of this study was to develop and validate a nomogram for predicting residual cavity formation after video-assisted thoracoscopic decortication in patients with chronic tuberculous empyema (CTE). METHODS: We retrospectively analysed patients who were diagnosed and treated for CTE at our hospital from January 2017 to December 2020. We used univariable and binary logistic regression analyses to identify independent risk factors. A predictive nomogram was developed and validated for predicting the risk of residual cavity formation after video-assisted thoracoscopic decortication in patients with CTE. The receiver operating characteristic (ROC) was used to evaluate the nomogram. RESULTS: Data from 103 patients were analysed. The contact area between the lung and empyema (P = 0.001, odds ratio [OR] 1.017, 95% confidence interval [CI] 1.007-1.028), calcification (P = 0.004, OR 0.12, 95% CI 0.029-0.501) and thickness of the pleura (P = 0.02, OR 1.315, 95% CI 1.045-1.654) were risk factors for residual cavity formation after video-assisted thoracoscopic decortication. A 50% residual cavity formation rate was used as the cut-off to validate the nomogram model. The area under the ROC curve for the nomogram was 0.891 (95% CI, 0.82-0.963). The sensitivity and specificity of the nomogram were 86.67% and 82.19%, respectively. The calibration curve indicated good consistency between the predicted and actual risks. CONCLUSIONS: The preliminary nomogram could contribute to preventing postoperative residual cavity formation and making appropriate surgical decisions.

Repair of pectus excavatum in a patient with an Eloesser thoracostomy window: sequential extrapleural Nuss procedure and modified Ravitch procedure.

A 28-year-old man with a history of tuberculous empyema and pectus excavatum visited our hospital for progressive dyspnea and leg edema. The patient had undergone an Eloesser window operation for repetitive pleuro-cutaneous fistula due to chronic tuberculous empyema in the left thorax one year prior. Chest computed tomography demonstrated severe compression of the right ventricle and inferior vena cava and chronic empyema with the Eloesser window in the left thorax. Because conservative treatment had failed, the patient underwent a total extrapleural Nuss procedure, resulting in marked relief of compression and complete resolution of leg edema and congestive hepatopathy. However, he required ventilation support due to carbon dioxide retention. Therefore, the patient underwent a modified Ravitch procedure and was weaned off ventilation support. Herein, we represent the first report of a sequential extrapleural Nuss procedure and a modified Ravitch procedure in a patient with chronic tuberculous empyema with an Eloesser window.

Surgical outcomes and the factors affecting lung expansion following open window thoracostomy in chronic tuberculous empyema with destroyed lung.

BACKGROUND: Patients with chronic tuberculous empyema and destroyed lung on a prolonged intercostal tube with failed lung expansion considered unsuitable for single-lung ventilation have poor outcomes. The study's objective was to analyze the surgical outcomes and lung expansion factors in these patients following the open window thoracostomy (OWT) procedure. METHODS: In a prospective study, patients (males = 63, females = 12) diagnosed with tuberculosis who underwent OWT were analyzed between 2017 and 2018. Factors including age, sex, side, comorbidities, body mass index (BMI), bacteriological culture, and patency of OWT site were evaluated for lung expansion. RESULTS: Mean preoperative weight 40.96 ± 5.70 kg increased significantly postoperatively. Pseudomonas aeruginosa (30.66%) was the most typical organism isolated and smoking (21.3%) was the common risk factor. At 6-month follow-up, complete lung expansion was noted in 60% of patients, while partial and no expansion is seen in 17.3% and 22.3% patients. Similarly 82.4% patients with pre-operative BMI>18.5 kg/m2 had complete lung expansion, while with BMI < 18.5 kg/m2, 41.7% and 45.8% had partial and no-expansion. Complete lung expansion was seen in 97.1%, 18.2%, and 23.1% of patients with obliterated OWT, sputum, and pleural pus positive for acid-fast bacilli (active disease), while in 57.9% of patients with comorbidities, complete lung expansion was absent. CONCLUSION: The analysis of various factors concludes that lung expansion is not affected by age, sex, side of the disease, and co-morbid conditions; however, extensively diseased lungs with low BMI and positive bacteriological culture, especially P. aeruginosa, active disease, smoking, and patent OWT, interfered with the expansion of the lung.

Approach to empyema necessitatis.

BACKGROUND: Thoracic empyema is a collection of pus in the pleural space. Empyema necessitatis is a rare complication of empyema, characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. We present nine cases of empyema necessitatis, including etiology, duration, and characteristics of clinical history, kind of surgery used, and treatment choices. METHODS: In a 4-year period nine patients were treated for empyema necessitatis. Six were male and 3 female with an age range of 13-89 years (median=40 years). RESULTS: Empyema necessitatis was treated with drainage and antibiotherapy or antituberculosis therapy in three patients with the diagnosis of tuberculosis or nonspecific pleuritis. Decortication of the thoracic cavity was used in three patients successfully. Others were treated with open drainage. Final diagnoses were tuberculous empyema in five patients, chronic fibrinous pleuritis in three, and squamous cell carcinoma in one. Except for two patients, one with multisystem failure and one with squamous cell carcinoma, all were discharged with no complications. CONCLUSION: Surgery plays a critical role in the management of empyema necessitatis in selected patients. Tube drainage, open drainage, and decortication are the choices in variable conditions for obliterating the cavity and regenerating pulmonary function.

Spontaneous haemoptysis as a late complication of plombage in a tuberculosis patient.

The endemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculous drugs had led to a renaissance of the surgical tuberculosis therapy until the early 1950s. Late complications of plombage performed decades before are rare and are mainly related to infection and/or migration of the inserted foreign material and are scarcely recognized today. We report on a 73-year-old male patient, who was admitted to the emergency room of our hospital with acute massive haemoptysis for four days. On physical examination the patient presented with decreased breath sounds over the left lung and an old left-sided thoracotomy scar. Radiological findings and bronchoscopy revealed an empyema and a fistula as late complications 53 years after collapse therapy with insertion of a plombage for the treatment of pulmonary tuberculosis. The endobronchial nylon threads in the left bronchial tree and the fistula ending in the left lower bronchus confirmed our diagnosis. The patient was successfully treated by resection of the affected lower lobe. The present casuistic demonstrates a rare cause of spontaneous haemoptysis: late complications after extrapleural pneumolysis and plombage for cavitary tuberculosis over 50 years after the initial operation.

[A case of chronic tuberculous empyema with a fistula treated with an endobronchial Watanabe spigot before surgery].

A 78-year-old man was referred to our hospital because of pyrexia in October 2008. Chest X-ray films and chest computed tomography (CT) indicated chronic tuberculous empyema in the right hemithorax. His general condition was not improved by antibiotic treatment, and CT showed pyothorax with a niveau and bronchial fistulas in May 2009. We subsequently performed open window thoracostomy and decortication of the residual dead spaces, but the bronchial fistulas remained. As this approach makes it difficult to ensure the sterility of the cavity, we therefore performed fiberoptic bronchoscopy and occluded the bronchus with an endobronchial Watanabe spigot (EWS). However, the bronchial fistula recurred, and therefore we performed this treatment again. We continued to carefully wash the cavity and the leakage stopped, whereupon the cavity became sterile. We then performed omental pedicle and muscle flap closure and thoracoplasty in April 2010. The empyema was cured without any complications. These findings suggest that using an EWS before surgery can be highly effective in controlling chronic tuberculous empyema with fistulas.

Uniportal Thoracoscopic Decortication for Stage III Tuberculous Empyema With Severe Rib Crowding.

BACKGROUND: This study explored the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) decortication in patients presenting with stage III tuberculous empyema with severe rib crowding. METHODS: From August 2017 to January /2019, 33 patients with stage III tuberculous empyema and severe rib crowding underwent uniportal VATS decortication with partial rib resection and the use of a customized periosteal stripper. Preoperative and postoperative chest computed tomography (CT) imaging and pulmonary function testing were analyzed to evaluate the clinical significance of certain imaging findings and surgical efficacy. RESULTS: There was 1 conversion to open thoracotomy. Median operative time was 3.5 hours (range, 2.1-4.5 hours) and the median blood loss was 500 mL (range, 250-1000 mL). There were no perioperative mortalities. The incidence of prolonged air leaks (>5 days) was 81.8%. Median postoperative hospital stay was 4 days (range, 4-5 days). All patients were discharged with 2 chest tubes, and median duration drainage was 39 days (range, 30-60 days). The presence of a low-density line between the parietal fibrous pleural rind and chest wall was demonstrated on chest CT in 13 patients. Intraoperative blood loss was considerably lower in these patients compared with those without this imaging finding. Follow-up was complete in all patients over a median of 8 months (range, 6-11.5 months). All patients recovered well and achieved notable improvement in pulmonary function. CONCLUSIONS: Uniportal VATS decortication is safe and effective. Patients presenting with a low-density line around the thickened fibrous pleural rind on preoperative chest CT scan may be good candidates.

Risk factors associated with postoperative respiratory failure in tuberculous empyema patients.

ABSTRACT: Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.