Uchida T, Wada M, Sakamoto J, Arai Y
Department of Surgery, Aichi Prefectural Hospital, Okazaki, Japan.
Surg Today. 1999;29(2):186-9. doi: 10.1007/BF02482248.
We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (Picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.
我们在此报告一例采用血管栓塞线圈支气管内放置治疗支气管胸膜瘘的女性病例。她因术后脓胸需行灌洗术而被转诊至我院。9年前她曾因肺结核接受过胸廓成形术。然而，术后发生了支气管胸膜瘘，此后她不得不持续使用胸腔引流管。每2周用5KE的OK - 432（沙培林：中外制药）加100mg米诺环素对脓腔进行灌洗，持续3个月，脓胸的脓性分泌物显著减少。此后，通过放置血管栓塞线圈在支气管内封堵支气管胸膜瘘。术后不久，瘘口漏气停止，2天后拔除引流管。该患者在此次治疗后20个月时未经任何额外治疗，情况良好。作为支气管胸膜瘘合并脓胸的治疗方法，在考虑胸廓成形术和脓腔填充等根治性手术之前，先用OK - 432对脓腔进行灌洗直至清洁，然后通过支气管内放置栓塞线圈封堵瘘口，这种方法值得一试。
