Prognostic factors in pleuropulmonary decortications for tuberculous pyothorax

• Published in: Revue de pneumologie clinique Vol. 74; no. 1; pp. 16 - 21
• Main Authors: Issoufou, I, Lakranbi, M, Belliraj, L, Ammor, F Z, Harmouchi, H, Ouadnouni, Y, Smahi, M
• Format: Journal Article
• Language: French
• Published: France 01.02.2018
• Subjects: Chirurgie thoracique; Thoracic surgery; Tuberculosis; Chest tube; Empyema; Tuberculose; Cavité pleurale; Drainage thoracique; Thoracotomi; Thoracotomy; Empyème; Pleural cavity
• ISSN: 0761-8417
• DOI: 10.1016/j.pneumo.2017.12.001

Tuberculous pyothorax or empyema is one of the serious forms of tuberculosis and still poses public health problems. Through a series of patients who undergone pleuropulmonary decortication, we propose our model of management and determine the main factors prognostic. We retrospectively retrieved for 8 years 93 cases of patients with pleuropulmonary decortication for tuberculous pyothorax confirmed by histological examination pre- or postoperatively. There were 33 women and 60 men with an average age of 28.4 years±10.35. In all cases, the radiological findings showed a pachypleuritis associated with an enclosed pyothorax in 79.6% of cases (n=74), a free cavity pyothorax in 8.6% of cases (n=8) and a passive atelectasis in all these cases. Chest tube was performed before surgery in 91.4% of cases (n=85) until the effusion was completely drained. The univariate analysis of the results of the surgery allowed to determine 4 factors of good prognosis: preoperative preparation (including chest tube with total drying of the empyema, respiratory physiotherapy and weight gain) P=0.04, complete peroperative pulmonary re-expansion P=0.03, the lowest stay in intensive care unit P=0.02 and the follow-up P=0.01. Pleuropulmonary decortication is a safe therapeutic alternative in the late stages of tuberculous empyema with acceptable morbimortality.