[The role of surgery in the treatment of chronic empyema].

For the last ten years we had 56 patients operated for the empyema which occupied almost all the thoracic cavity. We evaluated their postoperative pulmonary functions and their sequelae. The pathological features of the resected lung and empyema wall were also examined. Surgical procedures consisted of 25 extraperiostal air plombage, 14 pleuropneumonectomy, 8 decortication, and 9 other procedures (lobectomy, muscle-flap, omental flap, and others). Preoperative %VC of patients with extraperiostal air plombage, those with pleuropneumonectomy, those with decortications and those with other procedures were 59.6 +/- 12.6, 46.4 +/- 11.1, 63.0 +/- 10.1, and 53.8 +/- 11.7 respectively. Of 11 patients who developed severe respiratory impairments (%VC less than 40 and/or FEV 1/VC predicted less than 30) post operatively, 4 had extraperiostal air plombage, 4 had pleuropneumonectomy, and 3 had other procedures. In general, degree of respiratory impairment was more severe in patients who underwent multiple surgical procedures. Of 18 patients who survived 5 years or more, %VC was under 50% in 9, and of those nine patients five had 30% decrease in VC compared to the preoperative values and there were 2 patients with extraperiostal air plombage in whom extreme shrinkage and deformity of hemithorax were observed though they had neither additional surgeries nor recurrences. Hemangioma was often seen on the walls of empyema and in some they became so large as to cause mediastinal shift. There were patients with round atelectasis, which, we thought, could have caused abscess or inflammatory granuloma.