SURGICAL TREATMENT FOR TUBERCULOUS THORACIC EMPYEMA IN JAPAN
1979 Volume 54 Issue 4 Pages 249-256
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1979 Volume 54 Issue 4 Pages 249-256
Annual trend in the number of surgically treated cases, preoperative background facters, surgical procedures applied and the results of treatment were studied in 1, 550 cases of tuberculous thoracic empyema, who were treated surgically during 8 years period from 1968 to 1975 at 50 institutions belonging to the Tuberculosis Research Committee, RYOKEN.
The number of surgically treated cases per year was around 200, and no remarkable difference was found in the number by year during the observation period.
Preoperative background factors of subject cases were as follows: 8.5% were acute empyema and 91.5% chronic empyema, 55.6% were primary empyema and 44.4% secondary empyema, 71.0% were fistulous empyema and 29.0% non-fistulous empyema, 44.7% were total empyema and 55.3% partial empyema, 50.2% were cases with FEV1.0/VCpred. less than 40 and 49.8% more than 41, 41.4% were cases with microorganism in empyema space and 34.5% without microorganism in empyema space and 24.1% were cases with unknown bacteriological findings.
Surgical procedures employed were as follows: 26.5% were pleurectomy, 15.7% decortication, 43.4% space reducing method, 10.2% drainage method and 4.2% other procedures. The proportion of percentages surgical procedures was different considerably by preoperative back ground factors.
The over all results of surgical treatment were as follows: the successful rate was 80.7%, the unsuccessful rate 13.6% and the death rate 5.7%. These results were also affected remarkably by preoperative background factors.
The results of surgical treatment under the combination of preoperative background factors and surgical procedures employed were as follows: the successful rate in cases with good preoperative background factor was higher, and also the unsuccessful rate and the death rate in such cases were lower than those in case with poor preoperative background factor, in all kinds of surgical procedures employed. Preoperative lung function and bacteriological fin-liag3 in empyema space influenced remarkably the results of surgical treatment.
Comparing the results of surgical treatment obtained in the previous study carried out around 10 years ago from 1958 to 1967 and the results obtained in the present study, no difference waslfound in the successful rate of both studies. The unsuccessful rate in the present study was higher and the death rate was lower than those in the previous study.
