Treatment outcomes in patients with tuberculous pleural empyema

Objective. To improve treatment of patients with pleural tuberculosis. Material and methods. We analyzed medical records of 887 patients. All patients received treatment for pleural tuberculosis and pulmonary tuberculosis complicated by pleural tuberculosis between 2003 and 2022. Patients were divided into three groups. Group I included 211 patients with stage I pleural tuberculosis; group II — 73 patients with stage II pleural tuberculosis; group III — 603 patients with stage III pleural tuberculosis. Results. Comprehensive treatment incorporating surgical methods was performed in 743 patients. Among 1.338 surgical procedures, intraoperative complications occurred in 48 (3.6%) cases. These were injury of major vessels in 10 cases, opening of empyema in 29 cases, injury of pleural sac during transsternal occlusion of the main bronchus in 10 cases and diaphragmatic injury in 1 case. Postoperative complications were observed in 90 patients (6.7%). Ten (1.13%) patients died in a hospital, and all ones underwent surgery for stage III empyema. As a result of comprehensive treatment with surgical methods, tuberculous empyema regressed at discharge in 721 (97%) patients. Empyema was cured in all patients with stage I and II, as well as in 581 patients (96.4%) with stage III disease. Conclusion. Immediate outcomes of comprehensive surgical treatment of pleural and pulmonary tuberculosis complicated by tuberculous empyema largely depend on stage of pleural empyema. Stage I patients achieved full treatment response without complications or mortality. Stage II patients (95.9%) did not achieve full treatment response with closure of lung cavities and cessation of bacterial excretion, despite elimination of empyema and no mortality. Treatment of stage III tuberculous empyema was associated with the highest incidence of intraoperative (3.9%) and postoperative (7.3%) complications, in-hospital mortality (1.66%) and lower efficacy (90.9%).