Misthos P, Kakaris S, Sepsas E, Athanassiadi K, Skottis I
First Thoracic Surgical Department, Sotiria General Hospital for Chest Diseases, Athens, Greece.
Respiration. 2006;73(4):525-8. doi: 10.1159/000093370.
Late postpneumonectomy bronchopleural fistula (LBPF) is a serious complication. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage.
The goal of this study was to estimate the effectiveness of the transsternal, transpericardial approach for bronchial stump repair in case of LBPF.
From 1996 to 2002, 1,294 lung resections for non-small cell lung cancer were performed at our department. Out of 412 pneumonectomies, 16 patients (3.8%) presented with LBPF after right pneumonectomy for non-small cell lung cancer. Thirteen of these patients were subjected to transsternal, transpericardial bronchial stump repair. They were followed postoperatively, and morbidity and mortality rates were recorded.
The interval between pneumonectomy and fistula diagnosis lasted from 12 to 85 months. The estimated sizes of the fistulae ranged from 5 to 21 mm, and the length of the bronchial stump was >1 cm only in 2 patients (15.3%).Due to persistent empyema, open-window thoracostomy was performed for definite treatment immediately after the operation for bronchial stump reamputation in 6 cases (46.1%). One patient (7.6%) died 3 months postoperatively due to bronchopleural fistula recurrence. This was also the only case of fistula recurrence.
LBPF usually needs definite management to save the patient's life. The transsternal, transpericardial approach is a safe and effective method.
肺切除术后晚期支气管胸膜瘘（LBPF）是一种严重的并发症。由于纵隔纤维胸以及肺动脉残端损伤的风险，通过侧胸壁切开术对支气管残端进行手术修复是一种危险的尝试。
本研究的目的是评估经胸骨、经心包途径修复LBPF患者支气管残端的有效性。
1996年至2002年，我们科室对1294例非小细胞肺癌患者进行了肺切除术。在412例全肺切除术中，16例（3.8%）非小细胞肺癌患者在右全肺切除术后出现LBPF。其中13例患者接受了经胸骨、经心包支气管残端修复术。对他们进行术后随访，并记录发病率和死亡率。
全肺切除术后至瘘诊断的间隔时间为12至85个月。瘘口估计大小为5至21毫米，仅2例（15.3%）患者支气管残端长度>1厘米。由于持续脓胸，6例（46.1%）患者在支气管残端再截肢手术后立即进行了开窗胸廓造口术以进行确定性治疗。1例患者（7.6%）术后3个月因支气管胸膜瘘复发死亡。这也是唯一一例瘘复发病例。
LBPF通常需要确定性治疗以挽救患者生命。经胸骨、经心包途径是一种安全有效的方法。
