Thoracoscopic Debridement of Empyema Thoracis
Section snippets
Patients and Methods
From April 1993 to March 1996, 44 patients with empyema thoracis resistant to medical therapy were referred for surgical treatment. Patients were not excluded on the basis of the duration of symptoms before referral or the duration of their in-patient medical treatment. Two patients were considered unsuitable for a thoracoscopic operation because of a history of previous thoracic operations on the side of the empyema. The remaining 42 patients underwent VATD. All patients had a chest x-ray
Results
The mean patient age was 50.8 ± 3.7 years in the VATD group and 53.3 ± 6.2 years in the OD group (p = not significant). Twenty-one of the 30 VATD patients (70%) had either a chest drain inserted or had undergone needle aspiration of the collection before transfer. This was also the case for 8 of the 12 patients in the OD group (66.7%) (p = not significant). Similarly, 21 (70%) patients in the VATD group were receiving intravenous antibiotics at the time of transfer (p = not significant), versus 8
Comment
Empyema thoracis is common in people of all age groups. The natural history has been characterized by Barrett [10]. In the acute (exudative) and intermediate (fibrinopurulent) stages, the lung retains its compliance and has the capacity to fully expand if the fibrin layer on its surface is removed and the pleural space evacuated. At 4 to 6 weeks after the development of the empyema, however, this fibrin layer becomes organized and forms a thick peel (chronic or organizing phase). At this stage
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