Efficacy And Comparison Of Medical Thoracoscopy And Non-operative Drainage In Management Of Empyema

Background:Pleural empyema is an infectious disease in which pathogens invade the pleural space and cause the collection of pus.It has attracted extensive attention due to its high morbidity and mortality.It can be subdivided into 3 stages:exudative stage,fibro-purulent stage and organizing stage.The treatment was based on the use of antibiotics,supplemented by the interventional drainage of pus.The interventions included non-operative chest tube drainage,medical thoracoscopy,video-assisted thoracoscopic surgery(VATS),and thoracotomy etc.The medical thoracoscope is a drainage method which can draw pleural effusion,remove pus and necrotic tissue,open the package and clean the pleural cavity.At the same time,it has little trauma,low cost and no need for general anesthesia.So in recent years,more and more medical thoracoscopes have been used in the treatment of empyema.Objective:To analyze the safety and efficacy of medical thoracoscopy and non-operative drainage in the treatment of pleural empyema respectively and compare the outcomes of them in different empyema stage.Methods:We performed a retrospective study reviewing the files of inpatients referred for empyema at ShanDong provincial hospital from January 2010 to June 2017.A total of 102 patients were included in the medical thoracoscopic group(M group)and 106 patients in the non-operative drainage group(N group).All the patients had clinical manifestations of empyema,and all the pleural effusion samples collected by punctured or drainaged were examined for pleural effusion routine,biochemical,exfoliative cytology,and bacterial culture.Once the diagnosis of empyema was established or suspected,all patients received broad-spectrum antibiotic and targeted based on the culture result and drug susceptibility testing if necessary.Record the basic data,comorbidities,auxiliary examination results,catheterization time,duration of hospital stay,and postoperative complications of the two groups.At the same time,formulate the efficacy criteria based on clinical symptoms,ultrasound or CT findings and follow-up treatment.Compare the safety and efficacy of two groups at last.Results:A total of 98 patients(96.1%)in group M and 95 patients(89.6%)in group N had total improvement.There was no statistical difference between both groups in terms of efficacy(P=0.072)and hospitalization times(P=0.223),but the duration of chest tubes difference was significant(P=0.040).The complications mainly included subcutaneous emphysema and hematoma,puncture point infection as well as localized pain,which occurred in groups M and N were 27.5%and 18.9%respectively,with no statistical significant(P=0.142).No shock and death happened in both groups.In exudative stage group,7 patients(100%)in group M and 35 patients(94.6%)in group N had total improvement,with no significant statistical difference in terms of efficacy,duration of chest tube and hospital stay.In fibro-purulent stage group,77 patients(78/77,98.7%)in group M and 57 patients(57/65,87.7%)in group N had total improvement.The differences of efficacy(P=0.018)and duration of chest tube(P=0.036)were both significant.In organizing stage group,14 patients(14/17)in group M and 3 patients(3/4)in group N had total improvement.There were no differences between the both groups in the efficacy(P=0.25709)and duration of chest tube(P=0.208).Conclusion:Our study confirms that empyema could safely and successfully be treated by medical thoracoscopy as well as non-operative drainage.However,the medical thoracoscopy is superior to nonoperative drainage in fibro-purulent stage because of better efficacy and less duration of chest tubes.