Hajjar Waseem M, Ahmed Iftikhar, Al-Nassar Sami A, Alsultan Rawan K, Alwgait Waad A, Alkhalaf Hanoof H, Bisht Shekhar C
Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Ann Thorac Med. 2016 Jan-Mar;11(1):71-8. doi: 10.4103/1817-1737.165293.
Video-assisted thoracoscopic surgical decortication (VATSD) is widely applicable in fibrinopurulent Stage II empyema. While, more chronic thick walled Stage III empyema (organizing stage) needs conversion to open thoracotomy, and existing reports reveal a lacuna in the realm of late stage empyema patient's management through VATS utilization, particularly Stage III empyema. We prospectively evaluated the application of VATSD regardless of the stage of pleural empyema for the effective management of late stage empyema in comparison to open decortications (ODs) to minimize the adverse effects of the disease.
All patients with pyogenic pleural empyema (Stage II and Stage III) in King Khalid University Hospital (KKUH) (admitted from January 2009 to December 2013) who did not respond to chest tube/pigtail drainage and/or antibiotic therapy were treated with VATSD and/or open thoracotomy. Prospective evaluation was carried out, and the effect of this technique on perioperative outcomes was appraised to evaluate our technical learning with the passage of time and experience with VATS for late stage empyema management.
Out of total 63 patients, 26 had Stage II empyema and 37 had Stage III empyema. VATSD was employed on all empyema patients admitted in the KKUH. VATSD was successful in all patients with Stage II empyema. Twenty-five patients (67.6%) with Stage III empyema completed VATSD successfully. However, only 12 cases (32.4%) required conversions to open (thoracotomy) drainage (OD). The median hospital stay for Stage III VATSD required 9.65 ± 4.1 days. Whereas, patients who underwent open thoracotomy took longer time (21.82 ± 16.35 days). Similarly, Stage III VATSD and Stage III open surgery cases showed significance difference among chest tube duration (7.84 ± 3.33 days for VATS and 15.92 ± 8.2 days for open thoracotomy). Significantly, lower postoperative complications were detected in patients treated with VATSD in terms of atelectasis, prolonged air leak, wound infection, etc.
VATSD facilitates the management of fibrinopurulent, organized pyogenic pleural empyema with less postoperative discomfort, reduced hospitalization, and have fewer postoperative complications. VATSD can be an effective, safe first option for patients with Stage II pleural empyema, and feasible in most patients with Stage III pleural empyema.
电视辅助胸腔镜手术剥脱术（VATSD）广泛应用于纤维脓性期II型脓胸。然而，更多慢性厚壁III型脓胸（机化期）需要转为开胸手术，现有报告显示在通过VATS治疗晚期脓胸患者领域存在空白，尤其是III型脓胸。我们前瞻性评估了VATSD在胸膜脓胸各阶段的应用，以有效管理晚期脓胸，并与开胸剥脱术（OD）进行比较，以尽量减少该疾病的不良影响。
在哈立德国王大学医院（KKUH）（2009年1月至2013年12月收治）的所有化脓性胸膜脓胸患者（II期和III期）中，对胸腔闭式引流管/猪尾引流管引流和/或抗生素治疗无反应的患者接受了VATSD和/或开胸手术治疗。进行了前瞻性评估，并评估了该技术对围手术期结果的影响，以评估我们随着时间推移在晚期脓胸管理方面对VATS技术的学习情况和经验。
在总共63例患者中，26例为II型脓胸，37例为III型脓胸。KKUH收治的所有脓胸患者均采用了VATSD。VATSD在所有II型脓胸患者中均获成功。25例（67.6%）III型脓胸患者成功完成了VATSD。然而，只有12例（32.4%）需要转为开胸（手术）引流（OD）。III型VATSD患者的中位住院时间为9.65±4.1天。而接受开胸手术的患者住院时间更长（21.82±16.35天）。同样，III型VATSD和III型开胸手术病例在胸腔闭式引流管留置时间方面也存在显著差异（VATS组为7.84±3.33天，开胸手术组为15.92±8.2天）。值得注意的是，在肺不张、持续漏气、伤口感染等方面，接受VATSD治疗的患者术后并发症明显较少。
VATSD有助于管理纤维脓性、机化性化脓性胸膜脓胸，术后不适更少，住院时间缩短，术后并发症更少。VATSD对于II型胸膜脓胸患者可能是一种有效、安全的首选方法，并且在大多数III型胸膜脓胸患者中是可行的。
