Objective:To compare the clinical outcomes of thoracic close drainage

closed chest drainage by rib resection

and decortication in treatment of pleural empyema in children

and to investigate the best intervention time for different surgical procedures. Methods: From Jun. 1993 to Jan. 2006

88 children with pleural empyema were treated surgically. Thoracic close drainage was performed on 38 patients; closed chest drainage by rib resection

on 43 patients; and decortication

on 7 patients respectively. Different surgical therapies were choosen depending on the phase of pleural empyema development. We analyzed the preoperative course of disease

the quantity of pleural effusion

effusion encapsulation

the drainage quantity during operation

average postoperative drainage quantity

average duration of drainage

average postoperative length of hospitalization

average full length of hospitalization and the cure rate. Results: The preoperative course and effusion encapsulation were significantly correlated with surgical procedure selection. Decortication had less average drainage during operation or afteroperation

and shorter postoperative drainage duration than thoracic close drainage or closed chest drainage by rib resection. Thoracic close drainage had more postoperative drainage than closed chest drainage by rib resection.The three surgical procedures had similar cure rate with the quantity of average operative and postoperative blood transfusion significantly different. Conclusion: Children with pleural empyema can be successfully treated by thoracic close drainage

closed chest drainage by rib resection or decortication. Though early thoracic close drainage has the least trauma

the three surgical procedures should be appropriately applied according to preoperative course

pleural effusion amount and effusion encapsulation.