In the resectional surgery for pleuropulmonary tuberculosis, the complication rate of postpneu
monectomy empuema with or without bronchopleural fistula ranges from 10% to 18.5%(1,7,9) This
serious complication usually occurs within the early postoperative course, however under circums
tances difficult to explain, late empyema sometimes develops several years after pneumonectomy or
pleurpneumonectomy.
Among approximately 300 pneumonectomies for pleuropulmonary tyberculosis during the last 11
years, the authors experienced 4 cases of late empyema occurred more than 4 years after pneumo
nectomy.
It is interesting to know how late empyema develop, and through careful review of available 3
cases it might provide some information useful in minimizing its occurrence.
1. Two of the 3 cases had sputum and pleural positive for tuberculosis on both microscopy and
culture, and the remaining one had streptococcus viridans.
2. Two of the 3 casos had extensive parenchymatous destruction with bronchopeural fistula and
one had cavitary disease at the time of operation.
3. Preoperatively sputum and pleural fluid conversion of acid fast bacilli was not obtained in 2
cases.
4. Two of the 3 cases had pleuropneumonectomy and the remaining one had pneumonectomy with
partial extrapleural dissection. In all 3 cases contamination of the pleural space during operation is
practically unavoidable, and small area of calcified lesion in the pleural space was not completely
eradicated at the time of operation in one case.
5. In 2 cases of which acid fast bacilli cultivated, improper major anti-tuberculous drugs had
given postoperatively for about 18 months.
6. After occurring late postpneumonectomy empyema more than 4 years, pleural fluid demonstr
ated acid fast bacilli in 2 cases, and Pseudomonas and Klebsiella in the remaining one.
7. One of the oatient with late postpneumonectomy empyema subsequently developed an esophago
pleural fistula secondary ro empyema.
8. Proper maintenance postoperative anti-tuberculous medication as well as preoperative care is
the most important, we think, to minimize late postpneumonectomy empyema for pleuropulmonary
tuberculosis.
|