[Study on postoperative perforation in patients with chronic empyema--reoperated cases].

In 18 cases undergone reoperation because of perforation after the initial operation for primary and secondary chronic empyema during the period from 1974 through August 1986, we evaluated findings of fistula, procedures and causes of failure of the initial operation, and procedures and results of reoperation. Subjects consisted of 16 cases of chronic empyema complicated with pulmonary tuberculosis, 1 case of group III nontuberculous mycobacteriosis, and 1 case of chronic empyema secondary to pulmonary fibrosis. All patients had fistula at the initial operation. The initial operation was performed by Kinchu method in 8 cases, pulmonary detachment in 6 cases, and thoracic cavity reduction chiefly by a modification of Grow's method in 4 cases. The initial operation failed because of incomplete closure of the fistula in 11 cases (61%) and appearance of new fistula in 7 cases (39%). In reoperation, the fistula was closed by pedicle muscle plombage in 1 case undergone the initial operation by Kinchu method, while thoracic cavity reduction chiefly by a modification of Grow's method in all of the other 17 cases. After the operation, 15 patients (83%) were cured, 16 patients (89%) could be socially rehabilitated and 2 patients (11%) had recurrence of empyema. Two recurrent patients died from hepatitis and exacerbation of nontuberculous mycobacteriosis, respectively. Out of 10 patients undergone pedicle muscle plombage, 8 patients (80%) were cured. From these findings, we consider that the results of one stage operation can be improved by applying pedicle muscle plombage for closure of fistula after the initial operation following treatment with effective antibiotics.(ABSTRACT TRUNCATED AT 250 WORDS)