[Treatment of secondary empyema following lung resection complicated with internal fistula]

To clarify the results of treatment of secondary empyema following lung resection complicated with internal fistula, 81 cases treated at 31 different institutions during the 5 years period from 1983 to 1987 were analysed. 1) All cases of thoracic empyema treated surgically and secondary empyema following lung resection complicated with internal fistula did not decreased during the study period, in spite of the remarkable decrease of surgical cases for pulmonary tuberculosis. 2) The highest rate was observed in males over 50 years of age. 3) Bacteriologically positive case in empyema space was occupied about 70%. 4) 196 operations (including drainage) of 17 types were performed on 81 patients. Only 16% of the cases were successfully treated with one stage of operation. 5) Principal surgical procedure applied in cases under this study was drainage followed by closure of fistula with muscle plombage and with or without thoracoplasty. Case of air plombage and omental pedicle flap plombage have increased recently in Japan. 6) Success rate was 55.6%, failure rate was 32.1% and the mortality was 12.3%. These results indicate the difficulty involved in treatment. Therefore, to avoid occurrence of secondary empyema cases, careful selection of surgical indication, sufficient training in surgical technique and good preoperative and postoperative management are crucial.