OBJECTIVE Thoracic empyema in uremic patients on maintenance hemodialysis is a challenging situation. The clinical characteristics are rarely reported, and the surgical outcomes remain unclear. We report our experience with video-assisted thoracoscopic surgery in these patients during 10-year period of time. METHODS Between 2005 and 2015, we retrospectively reviewed the clinical characteristics, bacteriological studies, and thoracoscopic surgical results of 23 empyema patients undergoing maintenance hemodialysis. RESULTS The mean patient age was 67.1 ± 12.9 years. All patients had additional preexisting systemic diseases. The mean duration of hemodialysis was 34.7 ± 25.8 months. The infections causing empyema were pneumonia in 11 (47.8%), blood stream infection in 8 (34.8%), and uremic pleuritis in 4 (17.4%). Among the 22 identified microorganisms, the most common pathogen was methicillin-resistant Staphylococcus aureus (31.8%). After thoracoscopic surgery, 8 patients (34.8%) required additional procedures for complications, including 2 patients who required repeated thoracoscopy for hemothorax and 6 (26.1%) patients who required open drainage for residual empyema. The mean hospital stay was 62.4 days, and 6 patients (26.1%) died in the hospital. Univariate and multivariate analyses revealed that maintenance hemodialysis longer than 5 years was a significant factor associated with in-hospital mortality (odds ratio: 14.8, 95% confidence interval 1.5-151.6; p < 0.0001). CONCLUSION While surgical management of thoracic empyema in uremic patients undergoing maintenance hemodialysis is associated with high rates of complication and mortality, thoracoscopic surgery is feasible, especially for patients undergoing hemodialysis for less than 5 years.

中文翻译：

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维持性血液透析患者胸腔积脓的电视胸腔镜手术。

目的 维持性血液透析尿毒症患者的胸腔积脓是一个具有挑战性的情况。临床特征很少报道，手术结果仍不清楚。我们报告了我们在 10 年期间对这些患者进行视频辅助胸腔镜手术的经验。方法 回顾性分析2005-2015年23例接受维持性血液透析的脓胸患者的临床特征、细菌学研究和胸腔镜手术结果。结果 患者平均年龄为 67.1 ± 12.9 岁。所有患者都有其他预先存在的全身性疾病。血液透析的平均持续时间为 34.7 ± 25.8 个月。引起脓胸的感染为肺炎11例（47.8%），血流感染8例（34.8%），尿毒症胸膜炎4例（17.4%）。在已确定的 22 种微生物中，最常见的病原体是耐甲氧西林金黄色葡萄球菌（31.8%）。胸腔镜手术后，8例（34.8%）患者因并发症需要额外手术，其中2例因血胸需要重复胸腔镜检查，6例（26.1%）因残留脓胸需要开放引流。平均住院时间为 62.4 天，6 例患者（26.1%）在医院死亡。单变量和多变量分析显示，维持性血液透析超过 5 年是与住院死亡率相关的重要因素（优势比：14.8，95% 置信区间 1.5-151.6；p < 0.0001）。结论 虽然接受维持性血液透析的尿毒症患者胸部脓胸的手术治疗与高并发症和死亡率相关，