From: Wang Cheng, Jin Feng, Yang Baoling, et al. “Surgical treatment of tuberculous pustulothorax”, published in Chinese Journal of Surgery, 2004, 42(22): 1402-1403
Pleural fibrous plate stripping is the preferred method and the best procedure for the surgical treatment of chronic abscess chest, and it can also be the first procedure for all chronic abscess chest surgeries.
In simple abscess chest without lesions in the lungs, total pleurodesis should be performed as much as possible, not only to remove the thickened fibrous plate that constitutes the abscess cavity but also to fully release the lung and diaphragm, so that the pleural cavity can be reconstructed. This procedure not only completely releases the fibrous plate from the lung, but also restores the movement of the thorax and diaphragm, which is conducive to the elevation of the diaphragm and the displacement of the mediastinum to eliminate the residual cavity, and plays an important role in the improvement of lung function. Wang Cheng, Department of Thoracic Surgery, Shandong Provincial Chest Hospital
If the residual cavity is still left after the removal of the fibrous plate of the dirty layer and the release of the lung and diaphragm, additional local thoracoplasty can be performed in one stage, or the drainage time can be prolonged and the decision of additional local thoracoplasty can be made according to the review. Pleural exfoliation with additional limited thoracic reformation can achieve the purpose of infection control and elimination of residual cavity, while maximizing the preservation of lung function and reducing thoracic deformity.
In patients with stable lesions and residual cavities after treatment of pure tuberculous pleurisy, as the disease progresses, thick fibrous plates are formed on the pleural surface, and even calcification occurs, which restricts both lung expansion and movement of the thorax and diaphragm, resulting in more serious impairment of lung function, and the ventilation/blood flow ratio decreases due to the compression of lung tissue in the corresponding parts of the lesion, which can lead to different degrees of hypoxemia. In this group of patients, elimination of residual cavities and improvement of lung function are the main focus of treatment. Patients with bilateral lesions, in particular, can die from respiratory failure due to restrictive ventilation impairment due to severe pleural calcification and thoracic collapse.