暂无摘要。

BACKGROUND: Patients with tuberculous empyema (TE) can have a serious impact on lung function as their disease progresses, and, if left untreated, can cause damage to other parts of the body such as the thorax and spine, causing pain and inconvenience to the patient. Early diagnosis and the search for appropriate treatment are key to improving the survival rate of the disease.
METHODS: We report a case of a young patient with an unexpected finding of right pleural effusion on physical examination, who was eventually diagnosed with TE using next-generation sequencing of pleural tissue. We analyzed the literature to improve clinicians\' understanding of TE and how to properly diagnose and treat the disease.
RESULTS: Laboratory results of the pleural effusion suggested a possible Mycobacterium tuberculosis infection, but pathogen-related tests were negative, and the diagnosis was eventually successfully confirmed by thoracoscopic pleural biopsy.
CONCLUSIONS: The diagnosis of TE should be considered in young patients with pleural thickening of the empyema. Adenosine deaminase may provide diagnostic direction in patients with unexplained thorax abscess. Pleural biopsy, although an invasive procedure, is an essential diagnostic tool in some cases.

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.
目的： 探讨利用单孔胸腔镜彻底清创术治疗结核性脓胸合并胸壁结核的可行性和技术要点。 方法： 回顾性分析2019年3月至2021年8月38例在同济大学附属上海市肺科医院胸外科接受单孔胸腔镜彻底清创术治疗脓胸合并胸壁结核患者的资料。男性23例，女性15例，年龄［M（IQR）］30（25）岁（范围：18~78岁）。所有患者全身麻醉下清理胸壁结核后经由肋间窦道扩大成单孔切口，以单孔脓胸纤维板剥脱的方法进行全纤维板剥脱术，胸膜腔内置入胸腔引流管引流，胸壁结核处置入SB管负压引流，不采用肌瓣填充及加压包扎。无漏气时先拔除胸腔引流管，2~7 d后复查CT无明显残腔则拔除SB管后继续抗结核治疗。门诊及电话随访至2022年10月。 结果： 手术时间2.0（1.5）h（范围：1~5 h），术中出血量100（175）ml（范围：100~1 200 ml），术后最常见并发症为延长漏气，发生率为81.6%（31/38）。术后胸腔引流时间14（12）d（范围：2~31 d），术后SB管引流时间21（14）d（范围：4~40 d）。随访时间为25（11）个月（范围：13~42个月），所有患者切口均一期愈合，随访期间结核无复发。 结论： 单孔胸腔镜彻底清创术治疗结核性脓胸合并胸壁结核是安全可行的，结合术后规范的抗结核治疗，远期恢复效果良好。.

To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.

The literature on childhood tuberculous empyema (TE) is limited. The aim of this study was to examine the clinicopathological characteristics and outcome of paediatric TE and methods of prompt diagnosis and treatment. Between January 2014 and April 2019, 27 consecutive patients with TE aged ≤15 years [mean (SD) 12.2 (3.3), range 6-15] were retrospectively reviewed. The following were reviewed: baseline demographics, symptoms, laboratory and pathological examination, radiographical findings, microbiological data, anti-tuberculous and surgical treatment and clinical outcome. Acid-fast bacillus (AFB) smear, culture, TB real-time (RT) polymerase chain reaction (PCR) and T-SPOT.TB assay were reviewed. Six (60%) of 10 patients were TB-RT-PCR-positive in pus or purulent fluid. Twenty-three of 24 (95.8%) were T-SPOT.TB-positive. Decortication by surgical thoracotomy or thoracoscopy was performed in 22 (81.5%) patients. None of the 27 patients had specific complications such as pyopneumothorax or bronchopleural fistula and all were successfully treated. In childhood TE, aggressive surgical management is associated with a favourable outcome.Abbreviations: AFB, acid-fast bacilli; E, ethambutol; EPTB, extra-pulmonary TB; H, isoniazid; HIC, high-income countries; LMIC, low- and middle-income countries; MTB, Mycobacterium tuberculosis; PCR, polymerase chain reaction; PTB, pulmonary TB; R, rifampicin; RT, real time; TB, tuberculosis; TE, tuberculous empyema; Z, pyrazinamide.

Objective: To investigate the clinical efficacy, safety and feasibility of \"double-portal\" video-assisted thoracoscopic surgical(VATS) decortication among patients with stage Ⅲ tuberculous empyema, and then to evaluate the recovery of chest deformity. Method: This study was a single center retrospective study. A total of 49 patients with stage Ⅲ tuberculous empyema who underwent VATS pleural decortication at the Department of Thoracic Surgery, Public Health Clinical Center of Chengdu between June 2017 and April 2021 were enrolled, including 38 males, and 11 females, aged 13-60 (27.5±10.4) years. The safety and feasibility of VATS were further evaluated. The inner circumference of the chest on sternal and xiphoid planes on chest CT scans before and 1, 3, 6, 12months after decortication were collected through the measuring software of the CT. The samples in-pair test was used to compare the changes in the chest to reflect the recovery of the chest deformity. Results: In the 49 patients, The surgical time was (186±61) min, and the volume of blood loss was (366±267) ml. There were 8 cases (16.33%) with postoperative complications during the perioperative period. Constant air leak and pneumonia were the main postoperative complications. No relapse of empyema or dissemination of tuberculosis occured during the period of follow-up. Before surgery, the inner thoracic circumference of the thorax at the level of the carina plane was (655±54) mm, and the inner thoracic circumference of the thorax at the level of the xiphoid plane was (720±69) mm. Patients were followed for 12-36 months. The inner thoracic circumference of the thoracic cavity at the level of carina was (666±51), (667±47) and (671±47) mm at the 3rd, 6th and 12th months after operation, which were significantly larger than that at the level of carina before operation (all P<0.05). The inner thoracic circumference diameter of the thoracic cavity measured at the xiphoid level at the 3rd, 6th and 12th months after the operation was (730±65), (733±63) and (735±63) mm respectively(all P<0.05).The inner thoracic circumference of the thoracic cavity increased significantly than that before surgery (P<0.05). At 6 months after operation, there was significant difference in the improvement of the inner thoracic circumference of the carina plane in patients with age less than 20 years and FEV1% less than 80% (P=0.015, P=0.003). The improvement in the inner thoracic circumference of the carina plane in patients with pleural thickening≥8 mm compared with those with less than 8 mm was not statistically different(P=0.070). Conclusions: For some patients with stage Ⅲ tuberculous empyema, pleural decortication under thoracoscopy is safe and feasible, and can significantly restore the inner thoracic circumference of the patient\'s chest, improve the collapse of the patient\'s chest, and have significant clinical effect. The \"double-portal VATS\" surgical technology has the advantage of less trauma, wide operation field, large operation space and is easy to master, which is worth further exploring for clinical application.
目的： 探讨“两孔法”胸腔镜胸膜剥脱术对Ⅲ期结核性脓胸患者的临床疗效及其对胸廓形态恢复的影响。 方法： 本研究属于单中心回顾性研究，收集2017年6月至2021年4月在成都市公共卫生临床医疗中心胸外科接受胸腔镜胸膜剥脱术的Ⅲ期结核性脓胸患者49例，其中男性38例，女性11例，年龄13~60（27.5±10.4）岁，分析其临床特征及围手术期相关资料，探究其安全性及可行性，利用CT自带软件分别测量患者术前、术后隆突及剑突层面胸廓周长，将术前、术后胸廓周长通过配对样本t检验的方法对比分析术后患者胸廓塌陷恢复情况。 结果： 49例患者手术时间（186±61）min，术中出血量（366±267）ml，围手术期8例（16.33%）患者出现术后并发症，主要为术后肺持续漏气及肺部感染等，术后随访期间无脓胸复发及结核播散。术前经隆突层面胸廓周长为（655±54）mm，经剑突层面胸廓周长为（720±69）mm，术后随访12~36个月，与术前胸廓周长相比，术后第1个月，经隆突层面及剑突层面胸廓周长分别为（658±50）和（724±66）mm，差异均无统计学意义（P=0.173、P=0.057）。术后第3、6、12个月经隆突层面胸廓周长分别为（666±51）、（667±47）和（671±47）mm，均较术前明显增大（均P<0.05）。术后第3、6、12个月，经剑突层面测量胸廓周长分别为（730±65）、（733±63）和（735±63）mm，均较术前明显增大（均P<0.05）。术后第6个月患者年龄<20岁及FEV1占预计值%<80%者隆突平面胸廓周长改善差异有统计学意义（P=0.015、P=0.003），胸膜增厚≥8 mm者较<8 mm者隆突平面胸廓周长有所改善，但差异无统计学意义（P=0.070）。 结论： 对于部分Ⅲ期结核性脓胸患者，胸腔镜下胸膜剥脱术安全、可行，并可明显恢复患者胸廓周长，改善患者胸廓塌陷，临床疗效显著。“两孔法”的胸腔镜技术理念具有创伤小、手术视野广、操作空间大，技术容易掌握等优点，值得进一步探索其临床应用价值。.

OBJECTIVE: To examine the effectiveness of decortication to treat chronic tuberculous empyema (TE) using uniport video-assisted thoracoscopic surgery (VATS) versus conventional triport VATS.
METHODS: Data from consecutive patients with stage II or III TE who underwent decortication with either uniport VATS (uniportal group) between July and December 2017, or triport VATS between January and July 2018 (triportal group), were retrospectively analysed. VATS procedures were performed under general anaesthesia with double lumen endotracheal intubation and clinical outcomes were compared between the two groups.
RESULTS: Clinical data were comparable between the groups (20 patients in each) regarding demographic and baseline characteristics, operative and postoperative characteristics, surgical procedure-related complications, and postoperative adverse events. No surgical procedure-related complications occurred during the perioperative period in either group. Threshold values for mechanical pain at 8 h postoperatively were significantly higher in the triportal group versus the uniportal group. Furthermore, the incidence of nausea and vomiting was significantly lower in the uniportal versus triportal group. In the triportal group, one patient required readmission and further intervention due to recurrence.
CONCLUSIONS: Uniport VATS decortication for stages II and III TE may be a feasible and safe procedure in selected patients. Moreover, uniport VATS may be less painful than triport VATS.

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ2 test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ2=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ2=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ2=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.
目的： 探讨单孔胸腔镜纤维板剥脱术治疗耐药结核性脓胸的安全性和疗效。 方法： 回顾性分析2018年1月至2020年12月在武汉市肺科医院外科行纤维板剥脱术治疗的122例结核性脓胸患者的资料，男性100例，女性22例，年龄［M（IQR）］29.5（28.0）岁（范围：13~70岁）。根据手术入路和是否耐药，将患者分为三组，单孔耐药组（22例，行单孔胸腔镜纤维板剥脱术）、开胸耐药组（28例，行开胸纤维板剥脱术）、单孔敏感组（72例，行单孔胸腔镜纤维板剥脱术）。三组间手术和预后指标比较采用Kruskal-Wallis 检验、χ2检验两两比较采用Mann-Whitney U检验或Bonferroni法。 结果： 单孔耐药组、开胸耐药组和单孔敏感组的术中出血量［200（475）ml比300（200）ml比225（300）ml，H=2.74，P=0.254］和治疗效果（χ2=4.76，P=0.575）无明显差异。单孔耐药组比开胸耐药组有更长的手术时间和术后肺复张时间［302.5（187.5）min比200.0（60.0）min，U=171.0，P=0.007；4.5（3.0）个月比3.0（2.2）个月，U=146.5，P=0.032］，更短的术后引流时间和术后住院时间［9.5（7.8）d比13.0（10.0）d，U=410.0，P=0.044；12.0（7.8）d比14.5（4.8）d，U=462.2，P=0.020］，两组并发症发生率的差异无统计学意义［63.6%（14/22）比71.4%（20/28），χ2=0.34，P=0.558］。单孔耐药组比单孔敏感组有更长的术后引流时间［9.5（7.8）d比7.0（4.0）d，U=543.5，P=0.031］、术后住院时间［12.0（7.8）d比9.0（4.0）d，U=533.0，P=0.031］和术后肺复张时间［4.5（3.0）个月比3.0（2.0）个月，U=961.5，P=0.001］，两组手术时间［302.5（187.5）min比242.5（188.8）min，U=670.5，P=0.278］和并发症发生率［63.6%（14/22）比40.3%（29/72），χ2=3.70，P=0.054］无差异。 结论： 对于耐药结核性脓胸，单孔胸腔镜纤维板剥脱术可以获得与药物敏感结核性脓胸相当的治疗效果，患者恢复状况良好。.

Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians\' ability to distinguish this disorder.
[摘要] 肝细粒棘球呦病是由细粒棘球绦虫幼虫感染人或动物肝脏组织而引起的一种慢性寄生虫病。结核性脓胸是一 种慢性活动性感染性疾病，主要侵犯胸膜间隙引起内脏、壁胸膜增厚。同时感染上述两种疾病的患者较为罕见。本文报 道1例肝细粒棘球呦病合并结核性脓胸误诊为肝、肺细粒棘球呦病的病例，并结合相关文献进行分析讨论，旨在提高临 床医师对该病的鉴别能力。.

BACKGROUND: Stage III tuberculous empyema is a common disease of tuberculosis. Traditionally, it has been treated by thoracotomy or video-assisted thoracoscopic surgery with two to four incisions. But conventional surgery has large trauma, large bleeding volume and long recovery time. To our knowledge it is the first report of surgery for stage III tuberculous empyema with a mini single-port approach.
METHODS: A 23-year-old woman admitted to our hospital with complaints of intermittent chest pain for half a year. We got the diagnosis of stage III tuberculous empyema after medical treatment. Considering that the patient was young and unmarried, we decided to perform minimally invasive pleural decortication through a 2.5 cm single port. The operation time was 240 min, and blood loss was 100 ml. The patient recovered well and postoperative pain was mild.
CONCLUSIONS: This case demonstrates that single-port VATS with a smaller incision for the Stage III tuberculous empyema should be considered in well selected patients.