Abstract: Objective To explore the efficacy of thoracoscopic surgery combined with multiple therapeutic approaches in the treatment of chronic empyema. Methods A total of 27 patients with chronic empyema （2 cases complicated with bronchopleural fistula） treated between February 2021 and April 2024 were selected in the study. They underwent debridement and fibrous peel decortication via two-port video-assisted thoracoscopic surgery （VATS） performed by the same team of thoracic surgeons. Postoperatively, continuous pleural irrigation was administered with 3 000 mL/d of normal saline, followed by drainage. Once the irrigation fluid became clear, negative pressure suction was applied. In 2 cases with bronchopleural fistula, the bronchial fistula orifices were occluded via interventional techniques. Patients received postoperative treatment including antibiotics, Shenfu injection, and nutritional support. Results There were no perioperative mortalities. Two cases （7.4%） required conversion to a mini-thoracotomy. Intraoperative pulmonary air leakage occurred in five cases （18.5%）. Postoperatively, four patients （14.8%） developed pulmonary infections, one patient （3.7%） experienced early hypoxemia, and one patient （3.7%） developed septic shock. During follow-up, no recurrence of empyema was observed. Conclusion In this limited series, VATS combined with multiple therapeutic measures showed favorable short-term outcomes and an acceptable complication rate in the treatment of chronic empyema. However, its long-term efficacy and superiority remain to be verified by prospective controlled studies.

Key words: Video-assisted thoracoscopic surgery, Irrigation, Empyema, Negative pressure suction, Bronchopleural fistula