gms | German Medical Science

Despite permanent improvement in medical therapy, pleural empyema remains a challenging problem for the thoracic surgeon which could be treated with a multitude of therapeutic options.

Objective: Assessment of the efficiency in relation to applied treatment methods according to the stage of the disease.

Patients and methods: Retrospectively were analysed the data of 108 patients [average age – 42.9±16.94 (range from 17 to 78) years, male/female ratio – 3:1] with meta- and parapneumonic pleural empyema between 1998 and 2008. Based on the stages of pleural empyema there were presented the related therapeutic results.

Results: The average duration of the preclinical tretatment was 27.38±18.33(od 0 do 90) days.In the stage I were 1.9% (2/108),in the stage II 31.5% (34/108) and in the stage III 66.7% (72/108) of the patients. Decortication was performed in 60.2% (65/108) of patients. Less aggressive surgical treatment (some type of pleural drainage and VATS ) were done in 39.81% (43/108) of patients. The average duration of hospitalization was 22.71±19,66 (18–102) days.Majority of patients [96.3% (104/108)] were cured and the hospital mortality was 3.7% (4/108).

Conclusion: Early referral of all empyema patients to thoracic units for definitive therapy is recommended because unnecessary delay enables progression of the disease to the stage III which is more difficult for the treatment. Especially in stage III the open operative revision of a pleural empyema is the method of choice.Despite of more agressive tretament associated mortality is acceptable.