Mora Gemma, de Pablo Alicia, García-Gallo Cristina L, Laporta Rosalía, Ussetti Piedad, Gámez Pablo, Córdoba Mar, Varela Andrés, Ferreiro María J
Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, España.
Arch Bronconeumol. 2006 Aug;42(8):394-8. doi: 10.1016/s1579-2129(06)60553-3.
New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas.
We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope.
Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary.
The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.
已开发出新的内镜技术作为支气管胸膜瘘手术治疗的替代方法。本研究的目的是分析我们在内镜治疗此类瘘管方面的经验。
我们对经纤维支气管镜诊断为支气管胸膜瘘的患者进行了一项回顾性研究。分析了患者特征、基础疾病、瘘管大小及内镜治疗结果。内镜技术包括通过纤维支气管镜导管注射纤维蛋白封闭剂（组织黏合剂和/或纤维蛋白胶）。
1997年至2004年间，18例患者经纤维支气管镜诊断为支气管胸膜瘘。均为男性，平均（标准差）年龄62（12）岁。16例患者在肿瘤手术后诊断为支气管胸膜瘘，1例在肺移植后支气管缝合处发生，其余1例与包虫病引起的胸腔积液同时发生。瘘管大小为1毫米至10毫米（平均3.6[2.7]毫米）。14例患者应用了纤维蛋白封闭剂，2例诊断后直接进行手术，其余2例支气管胸膜瘘自行闭合。12例患者使用的纤维蛋白封闭剂为组织黏合剂，2例为纤维蛋白胶。同时进行胸腔引流，外科医生酌情给予抗生素治疗。4例支气管胸膜瘘合并脓胸的患者也进行了胸腔灌洗。12例患者的瘘管因内镜技术而闭合（85.7%），未观察到并发症。85.7%的患者纤维蛋白封闭剂应用少于3次。
在纤维支气管镜引导下注射纤维蛋白封闭剂闭合支气管胸膜瘘的成功率高且无并发症。该技术可避免手术。
