A Comparative Study Of Thoracoscopic Surgery And Traditional Closed Thoracic Drainage In The Treatment Of Stage Ⅰ And Ⅱ Empyema

1.Background and ObjectivesAs a common infectious disease in the thoracic surgery,empyema refers to the accumulation of suppurative pleural effusion in the pleural cavity.The widespread use of antibiotics has dramatically reduced its morbidity,but it still has a high mortality rate of 6% to 24% after suffering from it.The principle of empyema treatment is to control infection actively,drain pus quickly,promote lung re-expansion as soon as possible,and strengthen supportive treatment.Traditional thoracotomy is more traumatic,so the patients with abnormal cardiopulmonary function tests and the elderly are more difficult to tolerate,not to mention the severe complications.In the past,closed thoracic drainage or thoracentesis is primarily used.With the development of minimally invasive surgery,video-assisted thoracoscopic surgery(VATS)has been widely performed.Thoracentesis alone is only suitable for the condition that the pus is thin and the symptoms of systemic infection have been controlled.However,it may make the pus cavity isolate,increase the difficulty of drainage,lead to treatment failure,and not decrease the chance of repeat aspiration.In stage I and II of empyema,the fibrous peel has not formed,so VATS and traditional closed thoracic drainage have become the primary treatment choice.Comparing the effects of the two procedures provides a specific reference value for the selection of the treatment.For patients suffering from empyema,the total lung capacity is decreased due to the compression of lung tissue by parapneumonic effusion.Empyema is mainly characterized by restrictive ventilatory dysfunction,and the therapeutic effect of it depends mostly on the improvement of lung function after re-expansion.With the limited use of pulmonary function tests(PFTs),computer software technology’s progress makes it possible to reconstruct the lung and quantify its function.The advantages and disadvantages of the two treatments were explained by comparing the effect of the effect of lung re-expansion and lung volume improvement.2.MethodsThis study collected 62 patients with stage I and II empyema in the department of thoracic surgery,Subei people’s Hospital of Jiangsu Province from January 1,2016 to June 1,2020.32 patients in group A underwent traditional closed thoracic drainage,and30 patients in group B underwent thoracoscopic surgery.The admission criteria included(1)complete clinical data,including outpatient follow-up data,(2)patients with stage I and II empyema: symptoms,physical signs,imaging data,and test results met the conditions,(3)there are no absolute anesthesia and surgical taboos such as serious medical diseases,(4)there was no history of lung-related serious diseases or destructive surgery.The exclusion criteria included(1)coagulation dysfunction,(2)immunodeficiency patients,(3)bilateral empyema,(4)intervention of internal medicine or external hospital.The two groups’ general data were comparable,and the differences,including sex,age,location,etiology,preoperative blood cell analysis,and history of hypertension and smoking,were not statistically significant.The basic data of the two groups before and after operation were collected.Before and one week after the operation,the chest CT lung images were reconstructed by Mimics Medical 21.0,and the lung volume of each case was measured.Statistical analysis was performed by SPSS22.0.3.ResultsThe two groups’ operation processes were completed successfully.There were no exceptional pulmonary edema cases after re-expansion,pleural reaction,massive bleeding,and patients who need conversion to thoracotomy during the operation also not happened.Two groups are found statistically significant in the incidence of complications and prognosis(P < 0.05).Compared with closed drainage,the incidence of new postoperative atelectasis,air leakage,hypotension,and arrhythmia of thoracoscopic surgery was higher;however,the encapsulated effusion and persistent pulmonary infection were lower(P < 0.05).Two groups are found no statistically significant in preoperative lung volume in lung re-expansion(P > 0.05).Still,two groups are found statistically significant in lung volume one week after the procedure and the preoperative variation(P < 0.05).4.Conclusion1.Thoracoscopic surgery have advantages in postoperative recovery and prognosis than traditional closed thoracic drainage in the treatment of stage I and II empyema.2.Compared with closed drainage,the incidence of new postoperative atelectasis,air leakage,hypotension,and arrhythmia of thoracoscopic surgery was higher;however,the encapsulated effusion and persistent pulmonary infection were lower.3.The lung re-expansion effect in thoracoscopic surgery is significantly better than that of closed drainage.