To evaluate the safety and clinical efficacy of individualized comprehensive therapy for patients with bronchopleural fistula and refractory empyema.

From Jul. 2015 to Nov.2019, there were 12 patients with bronchopleural fistula accompanying refractory empyema admitted to our hospital.Their clinical data resulted from thoracic operation and pleural effusion were retrospectively analyzed. Among the 12 , 10 were male and 2 were female (all aged from 23 to 78 , with a median age of (60.75 ±15.05 ) years. And the initial treatment for those 12 patients included 4 cases of non-small cell lung cancer, 4 cases of benign lung disease, 3 cases of encapsulated pleural effusion and 1 case of malignant thymoma with lung metastasis. On the occurrence of pleural fistula , the infection was controlled by empyema drainage and the fistula was blocked by intervention. When the condition was basically stable, muscle flap transplantation and other comprehensive measures were performed to fill the abscess cavity . And individualized treatment was conducted according to the condition.

There was no perioperative death among the whole group. During a mean follow-up of 17.45 months, one patient died of tumor metastasis, one patient had recurrent small pyogenic cavity.And other ten patients had no bronchopleural fistula and abscess chest recurrence, and their muscle flap survived during the follow-up. Postoperative chest CT/MR showed the empyema cavity was satisfactorily obliterated with pedicle or free muscle flaps.

Individualized comprehensive treatment is an effective option for patients with bronchopleural fistula combined with refractory empyema, and may achieve promising short-medium-term results.