From: Wang Cheng The paper “A retrospective analysis of the surgical treatment of chronic tuberculous pustular chest 461” by Wang Cheng, Department of Thoracic Surgery, Shandong Chest Hospital Published in Chinese Journal of Surgery, August 2015, Vol. 53, No. 8, 53(8): 608-611 There are various surgical modalities for chronic tuberculous pustular chest, and the choice of surgical modality in surgical treatment is extremely critical The choice of surgical approach in surgical treatment is extremely critical and directly related to the success or failure of surgery and the quality of survival of patients. How to select the surgical modality with the best efficacy according to the specific situation of the patient and the existing medical level is still a realistic problem that needs to be emphasized and continued to be discussed. Pleural fibrous plate debridement is the preferred method and the best procedure for the surgical treatment of chronic abscess chest, and it can also be used as the first procedure for all chronic abscess chest surgeries. For simple abscess chest without lesions in the lungs, total fiber plate stripping outside the pericardium of abscess chest should be performed as far as possible. For those with large abscess cavities and difficulties in operating outside the pericardium of the abscess chest, full pleural fiberboard debridement can be performed after incision of the abscess cavity wall to clear the abscess cavity. For those who cannot tolerate total pleural fiberboard debridement or consider that residual cavity may be left after total pleural fiberboard debridement, fiberboard debridement with preservation of wall layer can be used. Second, thoracoplasty is still needed for such patients with severe irreversible tuberculosis lesions in the combined lungs or complicated bronchopleural fistulae, who are not suitable for pleurodesis or pleuropneumonectomy. Pleuropneumonectomy can completely remove the lesion and is suitable for patients with bronchiectasis who have a large cavity in the combined lung, repeated hemoptysis before bronchiectasis, combined bronchopleural fistula with ipsilateral destruction of the lung or thoracoplasty with atrophic compression of the chest wall that is ineffective. This operation is very traumatic, bleeding, and has a high rate of postoperative complications and death, and the residual cavity still needs further thoracoplasty, transplantation of tipped greater omentum or transfer of chest wall muscle flap to fill the abscess cavity, so the surgical indications should be strictly controlled. Minimally invasive treatment of tuberculous abscess chest At present, pleural fibrous plate debridement through conventional thoracic surgery incision is still the main means of surgical treatment of chronic tuberculous abscess chest, but there are also reports of using minimally invasive means for the treatment of chronic tuberculous abscess chest. We selectively used thoracoscopic-assisted small-incision pleurodesis for the treatment of chronic tuberculous pustulosis with satisfactory results. The key to the success of the operation lies in case selection, accurate positioning of the thoracoscopic observation port and selection of the operation port. V. The importance of compound surgery for tuberculous septic chest with relatively stable tuberculosis lesions in the lung, if residual cavity remains after the stripping of the fibrous plate of the dirty pleura and the release of the lung and diaphragm, and the diseased lung should not be over-expanded, additional local thoracoplasty can be performed in one stage. The use of this procedure in this group of patients not only cures the abscess chest and restores part of the lung function, but also avoids the recurrence of tuberculosis caused by over-expansion of the lung tissue. For patients with reversible intrapulmonary lesions combined with bronchopleural fistulas who are to undergo thoracoplasty, drainage should be performed first to improve the patient’s systemic symptoms, followed by lesion removal, fistula repair, and stripping of the dirty pleural fibrous plate, then adequate effective drainage should be performed, and the additional surgery should be decided according to the review. This procedure was used in this group of patients to control the infection and reduce and eliminate the residual cavity. Pleurodesis + lobectomy or partial lung resection can be used in cases of septic chest combined with tuberculosis cavities or large caseous lesions, bronchiectasis, lung abscess, destroyed lung lobes, bronchopleural fistula and other irreversible lesions in the lung lobes, pleurodesis + partial lung resection for peripheral tuberculosis lesions without bronchial lesions, pleurodesis + partial lung resection for patients with lesions involving almost the entire lung lobes or irreversible lesions in the lobe bronchi. Pleurodesis + lobectomy was chosen for patients with irreversible lesions involving almost the entire lobe or lobe bronchi. In patients with this combination and lung resection, the bronchial stump was sterilized, and after extra-luminal double sutures were applied at its root, stump trimming clamps were performed to remove the fragmented bronchial cartilage ring near the section, and the section was again sterilized intracavernally and the stump was sutured with several stitches in a full interrupted fashion. Pleural exfoliation failure or post-pneumonectomy abscess chest, lack of more effective treatment methods can be used muscle flap filling + limited thoracoplasty, this type of patients using this procedure, not only solve the shortage of available filling muscle flap, but also reduce the scope of thoracoplasty, compared with the traditional thoracoplasty has the advantages of less trauma, less bleeding, can significantly reduce the deformity and so on. In case of tuberculous septic chest combined with thoracic spine tuberculosis, thoracic spine tuberculosis lesion removal can be completed through thoracic incision at the same time, and different procedures should be adopted depending on the degree of adhesion between thoracic spine lesion and lung. In case of tuberculous septic chest with external penetration of the chest wall, additional incisions are sometimes required in addition to the open chest incision because of the variable extent of abscess flow from the chest wall. In these patients, in addition to closed chest drains, negative pressure drains are placed in the invasive chest wall, which are submerged in healthy muscle tissue and are drawn out from the opposite direction of fluid gravity when the patient is lying or standing, and are applied to negative pressure drainage. Placing the negative pressure drainage tube against gravity can reduce or avoid the formation of sinus tracts after extubation.