OBJECTIVES The goal of this study was to evaluate the safety and efficacy of decortication for stage III drug-resistant tuberculous empyema (TE). METHODS We analysed all patients with stage III TE who underwent decortication between March 2015 and October 2019 at Wuhan Pulmonary Hospital. The patients were divided into 2 groups according to drug-susceptibility testing of bronchoscopy lavage fluid, pleural effusion and tissue specimens, including a drug-resistant group and a drug-sensitive group. We collected and compared the preoperative, perioperative and postoperative data from the 2 groups to evaluate the safety and efficacy of decortication for stage III drug-resistant TE. RESULTS In total, 135 cases met the inclusion criteria and were enrolled, including 30 cases in the drug-resistant group and 105 cases in the drug-sensitive group. No deaths were recorded for the entire study population. Compared to the drug-sensitive group, the drug-resistant group had longer operation times (259.8 ± 78.4 min vs 187.2 ± 56.0 min, P = 0.00), a larger volume of intraoperative blood loss [300 (200,400) ml vs 200 (130, 300) ml, P = 0.00] and a higher intraoperative transfusion rate (5/30, 16.7% vs 4/105, 3.8%, P = 0.04). The rate of complications was significantly higher in the drug-resistant group (23; 76.7%) than in the drug-sensitive group (53; 50.5%) (P = 0.01). Recurrence was not reported in any of the patients. Twenty-three (76.7%) patients in the drug-resistant group and 90 (85.7%) patients in the drug-sensitive group recovered to an "excellent" level, and 3 cases in each group recovered to a "poor" level; there was no significant difference between the 2 groups in surgical effects (P = 0.21). CONCLUSIONS Decortication is a safe, effective and feasible option for patients with stage III drug-resistant TE, although the operation is difficult and risky.

中文翻译：

---

剥脱术治疗 III 期耐药结核性脓胸的安全性和有效性。

目的 本研究的目的是评估剥脱术治疗 III 期耐药结核性脓胸 (TE) 的安全性和有效性。方法 我们分析了 2015 年 3 月至 2019 年 10 月在武汉市肺科医院接受剥脱术的所有 III 期 TE 患者。根据支气管镜灌洗液、胸腔积液及组织标本药敏试验将患者分为2组，包括耐药组和药物敏感组。我们收集并比较2组的术前、围手术期和术后数据，以评估剥脱术治疗III期耐药TE的安全性和有效性。结果 共纳入135例符合纳入标准的患者，其中耐药组30例，药物敏感组105例。整个研究人群没有死亡记录。与药物敏感组相比，耐药组手术时间较长（259.8±78.4 min vs 187.2±56.0 min，P=0.00），术中失血量较多[300（200,400）ml vs 200（130 , 300) ml, P = 0.00] 和较高的术中输血率 (5/30, 16.7% vs 4/105, 3.8%, P = 0.04)。耐药组并发症发生率（23例；76.7%）明显高于药物敏感组（53例；50.5%）（P = 0.01）。没有任何患者出现复发的报道。耐药组23例（76.7%）和药物敏感组90例（85.7%）恢复至“优”水平，各3例恢复至“差”水平；2组手术效果无显着性差异（P=0.21）。结论 对于Ⅲ期耐药TE患者，摘除术是一种安全、有效、可行的选择，但手术难度大、风险大。