Maniwa Tomohiro, Saito Yukihito, Kaneda Hiroyuki, Imamura Hiroji
Department of Thoracic Cardiovascular Surgery, Kansai Medical University Hospital, Kansai Medical University, 10-15 Fumizono-Cho, Moriguchi, Osaka, Japan.
Eur J Cardiothorac Surg. 2006 Oct;30(4):652-6. doi: 10.1016/j.ejcts.2006.07.023. Epub 2006 Aug 28.
Bronchopleural fistula is a serious complication of pulmonary resection. For anatomical reasons, lower lobectomy is thought to carry a higher risk for bronchopleural fistula. We investigated the efficacy of bronchial stump reinforcement with a pedicled intercostal muscle flap after lower lobectomy and compared the responses in patients treated with the flap, without the flap, and with other types of flap. We also investigated whether harvesting the intercostal muscle flap leads to an increase in blood loss during surgery and whether the type of flap influences chest-tube volume and pain after surgery.
One hundred and sixty-eight patients had lower or middle-lower lobectomy between January 1990 and December 2004. The bronchial stumps were treated in one of the three ways: covered with an intercostal muscle flap (116 patients, group A), not covered with a muscle flap (32 patients, group B), or covered with free fat or pleura (20 patients, group C). In a separate study, we compared the blood loss during surgery, and chest-tube volume and pain after surgery between patients treated with the intercostal muscle flap (23 patients) and non-intercostal muscle flap (32 patients).
No patients in group A exhibited bronchopleural fistula, and two patients in group B and one patient in group C exhibited bronchopleural fistula. These differences were not significant. Blood loss, chest-tube volume, and pain score after surgery did not differ significantly between treatment groups.
Bronchial stump reinforcement with the intercostal muscle flap after pulmonary resection is safe and effective when performed during lower and lower-middle lobectomy and does not increase the risk of complications.
支气管胸膜瘘是肺切除术后的一种严重并发症。由于解剖学原因，下叶切除术被认为发生支气管胸膜瘘的风险更高。我们研究了下叶切除术后带蒂肋间肌瓣加固支气管残端的疗效，并比较了接受该肌瓣治疗、未接受该肌瓣治疗以及接受其他类型肌瓣治疗患者的反应。我们还研究了获取肋间肌瓣是否会导致手术期间失血增加，以及肌瓣类型是否会影响术后胸腔引流量和疼痛情况。
1990年1月至2004年12月期间，168例患者接受了下叶或中下叶切除术。支气管残端采用以下三种方法之一进行处理：用肋间肌瓣覆盖（116例患者，A组）、不用肌瓣覆盖（32例患者，B组）或用游离脂肪或胸膜覆盖（20例患者，C组）。在另一项研究中，我们比较了接受肋间肌瓣治疗的患者（23例）和未接受肋间肌瓣治疗的患者（32例）手术期间的失血量、术后胸腔引流量和疼痛情况。
A组无患者发生支气管胸膜瘘，B组有2例患者和C组有1例患者发生支气管胸膜瘘。这些差异无统计学意义。各治疗组术后失血量、胸腔引流量和疼痛评分无显著差异。
肺切除术后在下叶和中下叶切除术中使用肋间肌瓣加固支气管残端是安全有效的，且不会增加并发症风险。
