The experience of using thoracoscopic surgery for treatment of patients with acute nonspecific parapneumonic pleural empyema

Abstract

Objective. To evaluate the effectiveness of thoracoscopic operations and to study the clinical and epidemiological characteristic of patients with pleural empyema (PE). Materials and Methods. A retrospective analysis of 51 patients with PE treatment results has been done. All participants were examined by standard clinical and laboratory tests, X-rays and CT scans of the chest, ultrasound of pleural cavities. All patients (n = 51, 100%) were subject to thoracoscopic interventions. Results. The average age of patients was 44.4 ± 14.7 years. Men prevailed among them - 36 (71%). The first stage of PE was diagnosed in 18 (35%) patients, and the second - in 33 (65%). Almost all patients (50 patients – 98%) had been treated in other hospitals before hospitalization to a specialized department. Diagnostics of PE and patients admission to the thoracic surgery department took place on the 2 - 3 week of disease in 70% of cases. The main types of surgery on the first stage of PE were: 1) thoracoscopy with targeted drainage of pleural cavity and pleural biopsy (n = 4, 22%), 2) video-assisted thoracoscopic surgery (VATS) with destruction of fibrinous adhesions (n = 14; 78%). It has been done at the second stage of PE: 1) VATS pneumolysis (n = 22; 67%) and 2) VATS decortication of lung (n = 11; 33%). The positive results of pleural exudates bacteriological analysis have been obtained from 9 patients (18%). The median of pleural exudation duration at the first stage of PE was 5 days (4, 6), at the second stage - 6 (5, 9) days (p = 0.058). Good results were obtained in 33 patients (65%), satisfactory - in 15 (29%), unsatisfactory - in 3 (6%). The median of hospital stay duration was 18 (16; 21). There have not been lethal outcomes. Conclusions. Diagnosis of pleural empyema is a complex task and requires a broad introduction of modern techniques (CT and ultrasound). Standard microbiological testing is not effective in the diagnosis of PE pathogens, due to imperfection of anaerobic bacteria methods of detection and previous antibiotic therapy. The use of VATS in patients with PE on the first and the second stage is effective and reasonable, leads to good and satisfactory results in 95 % and 94 % of cases respectively.