Abstract:

Objective     To determine the optimal treatment of complicated parapneumonic effusions. Methods     Twenty-one patients with confirmed parapneumonic effusions were randomly divided to receive either chest tube pleural drainage plus streptokinase (CTSKs, n=10) or medical thoracoscopy (MTs, n=11). Outcome analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was performed.  Results    Compared with the CT-SK group, the MT group had a significantly higher primary treatment success ［10/11, 91% vs 4/9, 40%; P<0.05 Fisher′s Exact Test］, lower chest tube duration (5.8±1.1 vs 9.8±1.3 days; P<0.03), shorter total hospital days (8.7±0.9 vs 12.8±1.1 days; P<0.05), and less hospital costs (11045±3411 vs  18475 ±5164, P<0.05) also favored the MTs group. Of note, all the CT-SKs treatment failures could be salvaged with MTs, and none required thoracotomy.  Conclusion     In patients with complicated parapneumonic effusions and thoracic empyema, a primary treatment strategy of MTs is associated with a higher efficacy, shorter hospital duration, and less cost than a treatment strategy that utilizes catheterdirected fibrinolytic therapy.

Key words: Medical thoracoscopy; Complicated parapneumonic effusions