Abstract: Objective To explore the safety and feasibility of uniportal thoracoscopic decortication in the treatment of stage Ⅲ tuberculous empyema. Method From June 2020 to June 2022, 52 patients including 38 males and 14 females with stage Ⅲ tuberculous empyema who underwent uniportal thoracoscopic decortication were retrospectively analyzed in Department of Thoracic Surgery, The Third People's Hospital of Shenzhen. The mean age was (36.96±14.24) years (range:21 to 72 years). general After general anesthesia, a 4-5cm incision was made in the center of the pus cavity. In the case of severe intercostal stenosis, a section of rib was removed. And the outer parietal pleural space was separated. With the help of incision protector the thickened visceral parietal pleural fibreboard was removed free under a single hole. Follow‐up was performed in the outpatient clinic monthly. When there is no air leakage in the thoracic drainage tube, the color of the drainage fluid is pale, and the drainage volume is less than 100ml/d, the chest tube was removed. If chest imaging showed good lung dilation, the drainage volume of the trench drainage tube was <50ml/d, the trench drainage tube was removed, and the anti-tuberculosis treatment plan was formulated according to the bacteriological examination results. The postoperative follow-up was 12 months. The postoperative imagings were performed at 6 and 12 months.and compared with preoperative chest CT. Result Among the 52 cases, 27 cases had excellent recovery, 21 cases had good recovery and 4 cases general recovery. The excellent and good rate of postoperative cure was 92.3%,No patients had recurrence. Among the 52 patients, 51 cases underwent uniportal thoracoscopic decortications, and 1 case changed to thoracotomy. The operative time was (268± 110)min （range: 110 to 430）min; and median blood loss was (126±68)ml(range: 50 to 300 ml). All patients were discharged with 2 chest tubes, and the median duration drainage was(5±2.5) days (range: 3 to 16 days), and (9.0±2.8) days (range: 7 to 21 days) separately. The postoperative hospital stay was (5.0±2.5) days (range:3 to 7 days). There were no major complications except 1 case of prolonged lung leakage with the thoracic tube was removed 16 days after surgery, 2 cases of incision infection and 1 case encapsulated pleural effusion. Conclusion Uniportal thoracoscopic decortication is safe, feasible and effective for patients with stage Ⅲ tuberculous empyema.

Key words: Empyema, tuberculous, Decortication, Thoracoscopic