الفهرس 
Acknowledgement
Pleural AdhesionsOnly 14 pages are availabe for public view
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Abstract
This study was conducted during the period from October 2017 to March 2020 as a prospective randomized clinical trial in Assiut University Hospitals. The study was approved by the Scientific Ethics Committee of Faculty of Medicine of Assiut University, and informed written consent was obtained from the patients to deal with their data for scientific purposes. The objective of the study was to evaluate the efficacy and safety of different modalities for pleural adhesiolysis in patients who have sonographically proved septated pleural effusion and expected to benefit from pleural fluid drainage. Two chemical methods were evaluated in our study, the first is lysis of the adhesive bands by intrapleural instillation of streptokinase (STK), and the second is similar but by instillation of 2mercaptoethanesulfonate Na (MESNA). Two mechanical methods were also evaluated, the first is breaking up the adhesive bands and removing it by pulling and dissection via the medical thoracoscopy (MT), and the second is similar but by using instruments through the video-assissted thoracic surgery (VATS). During our study period, we encountered188 patients having septated pleural effusion, 100 patients who met the inclusion criteria of this study were included. Randomly, 25 patients were subjected to one of the four procedures designated for evaluation. Regarding the results of chemical adhesiolysis, intrapleural STK was able to achieve complete resolution of pleural adhesions in 18 (72%) of the 25 studied patients. Whereas, intrapleural MESNA was able to completely solve the problem of intrapleural adhesions in 16 (64%) of the 25 patients. Regarding the results of mechanical adhesiolysis, MT was able to achieve complete resolution of pleural adhesions in 18 (72%) of the 25 studied patients. Whereas, VATS was able to completely solve the problem of intrapleural adhesions in 22 (88%) of the 25 patients. Collectively and through the procedures used in this study, we were able to completely solve the problem of intrapleural adhesions in 74% of the 100studied patients and partially in 24% of the patients, while the failure was in only 2% of the patients. The mean duration of hospital stay among patients who underwent chemical adhesiolysis was significantly higher than that recorded with those subjected to mechanical adhesiolysis. However, patients subjected to chemical procedures had a lower complication rate compared to those underwent mechanical procedures.