On the classification of pleural empyema

Background. Empyema of the pleura is still an urgent problem of thoracic surgery, since mortality in this nosology reaches 10—20% according to literature data. Objective. To improve the treatment outcomes of patients with pleural empyema by optimizing the surgical approach to treatment using minimally invasive technologies. Material and methods. 635 patients with pleural empyema were treated at the Davydovsky State Clinical Hospital. Patients underwent various options for combined treatment using minimally invasive technologies, including drainage of the pleural cavity; videothoracoscopic rehabilitation, supplemented, if necessary, by bronchoblocking and the introduction of fibrin glue in the presence of a bronchopleural fistula; thoracostomy or decortication. Results. The use of an algorithm for choosing surgical tactics based on this classification made it possible to reduce mortality in this nosology to 4.56%. Conclusion. The improvement of methods of treatment of pleural empyema and the search for an algorithm of surgical tactics based on objective indicators such as data of chest CT and visual assessment of lung expansion is a promising area.