ABSTRACT
Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians’ ability to distinguish this disorder.
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Objective To observe the clinical efficacy of thoracoscopic pleural dissection in the treatment of non tuberculous empyema. Methods 48 non tuberculous empyema were selected from January 2015 to June 2017, according to the treatment methods, divided into the observation group (n = 24) and control group (n = 24), the observation group was treated with thoracoscopic pleural dissection treatment, the control group were treated with traditional thoracotomy for the treatment of more than two groups, effect of treatment. Results The observation group of patients with operation time, bleeding volume, drainage time and hospitalization time were significantly less than the control group (P < 0.05); the two groups of patients before treatment, FVC, FEV1, TLC compared no significant difference, no statistical significance (P > 0.05); after treatment, the patients' FVC, FEV1, TLC significantly increased (P < 0.05), and the patients in the observation group FVC, FEV1and TLC were significantly higher than that of the control group (P < 0.05). PO2, PCO2and WBC were significantly better than the treatment of two groups of patients after treatment, and the observation group of patients with PO2after treatment (80.30 ± 9.26) mmHg, PCO2(45.53 ± 4.27) mmHg and WBC (8.85 ± 3.62) g/L index was significantly better than the control group PO2 (70.33 ± 8.75) mmHg, PCO2(51.61 ± 5.40) mmHg and WBC (10.81 ± 4.00) g/L, the difference was statistically significant (P < 0.05). Conclusion Video-assisted thoracoscopic surgery for the treatment of non tuberculous empyema has less trauma and faster postoperative recovery.
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Objective To discuss the feasibility of single hole thoracoscopy of pleural fibreboard endarterectomy surgical treatment on chronic tuberculous empyema. Methods Retrospective analysis of minimally invasive treatment of 52 cases of chronic tuberculous empyema form January 2013 to May 2016, 50 cases applied single hole thoracoscopy surgery, video-assisted mini-thoracoscopy for another 2 cases. Results There was no death, operation time 60 ~ 240 min, average 160 min, bleeding 150 ~ 2000 ml, average 350 ml, postoperative chest tube drainage time 3 ~ 21 d, average 7 d, postoperative persistent leakage in 3 patients, 3 cases of atelectasis, incisional infection in 1 case, pleural effusion in 1 case, 3 cases of arrhythmia. All the cured patients are received the corresponding treatment, the follow-up of 3 ~ 36 m, the chest CT scan show no atelectasis. Conclusion Under the condition of strict selection of indication, single hole thoracoscopy of pleural fibreboard endarterectomy in treatment of chronic tuberculous empyema is safe and feasible, so it is worthy of making further clinical promotion and application.
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To evaluate the clinical value of gene chip technology (GCT) in detecting the mycoba-cteria,isoniazid and rifampin resistance of patients diagnosed tuberculous empyema.The 182 patients who met the inclusion criteria were enrolled to this study from January 2011 to December 2015,whose pus mycobacterial species were detected by GCT and MGIT,the simultaneous and sensitivity of them were compared.Meanwhile,36 patients diagnosed tuberculous empyema were selected to detect isoniazid and rifampin resistance.The simultaneous and sensitivity of GCT were evaluated base on the standard of MGIT.The 135 patients were diagnosed by tuberculous empyema.The specificity of GCT was same to MGIT (95.7％),the the sensitivity was 48.9％ (66/135)in GCT,26.7％ in MGIT,there was significant difference between them (x2=80.5,P＜ 0.05).The sensitivity,specificity and coincidence rate of GCT in rifampin resistance were 100％,the sensitivity,specificityand coincidence rate in INH were 50.0％(1/2),97.1％(33/34) and 94.4％.Gene chip technology for detection of mycobacteria has high sensitivity and specificity,which can identify non-tuberculous mycobacteria quickly.And it can also effectively detect the resistance of Mycobacterium tuberculosis to isoniazid and rifampicin.It has important significance in early diagnosis and treatment of tuberculous empyema.
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Objective To evaluate the efficacy of decortication by video-assisted thoracic surgery (VATS) in pa﹣tients with tuberculous empyema, and discuss its indications. Methods 60 patients with tuberculous empyema who underwent decortication by VATS for surgical management from December 2010 to December 2015 were included. Under a thoracoscope, we cleaned up the pus, separated adhesions, scraped granulation tissues and caseous necrosis on the inner wall of the abscess cavity, and stripped the thickened fiberboard of the parietal and visceral pleurae. Af﹣ter the procedure, sufficient drainage and antituberculosis therapy were carried out. Results All the patients in this group were operated successfully. All the patients were cured without perioperative death and complications. No re﹣currence of empyema was observed at the follow-up examination from 2 months to 5 years, and suffered pulmonary reexpansions were better. Conclusions The decortication by VATS for tuberculous empyema is safe, effective, mini﹣mally invasive. The imaging manifestations of pleural thickening in 1 cm, no obvious calcification, no serious lesions in the lungs are the indications for the operation.
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Objective To explore the efficacy of autologous pleural patch in surgical operation on the patient with chronic tuberculous empyema.Methods Autologous pleura patches were used to repair the pulmonary wound in the surgical operations for 7 patients with chronic tuberculous empyema,who received surgical management in Hebei Provincial Chest Hospital from August 2012 to November 2014.The leak time of the patient and the time of the chest tube were recorded,the pulmonary re-examination was observed by chest X-ray,and the follow-up results were recorded.Results The time of persistent pulmonary air leak of 6 patients was not more than 10 hours after operation,1 patient was not more than 24 hours.Review of X-ray chest showed that good for lung,4-7 d after operation removal of thoracic dosed drainage tube,there was no death and no chest infection in 7 patients and review of CT chest showed no significant residual cavity.After follow-up for 6-24 months 7 patients had satisfactory efficacy,there was no pneumothorax and thoracic infection,no residual cavily.Conclusion Autologous pleura can be used to patch the pulmonary wound in the surgical operation on the patient with chronic tuberculous empyema.