Wang Da-Li, Cheng Gui-Yu, Sun Ke-Lin, Meng Ping-Jin, Fang De-Kang, He Jie
Department of Thoracic Surgery, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhonghua Wai Ke Za Zhi. 2008 Feb 1;46(3):193-5.
To explore the methods of the treatment and the principles of the prevention of bronchus-pleural fistula (BPF) after pneumonectomy.
The clinical data of 15 cases of BPF after pneumonectomy in 815 lung cancer cases treated from July 1999 to June 2006 were analyzed retrospectively.
The occurrence rate of BPF after right pneumonectomy was 3.9% (12/310), higher than 0.6% (3/505) of left pneumonectomy (P < 0.01). The occurrence rate of BPF in cases with positive cancer residues in stump of bronchus was 22.7% (5/22), higher than 1.3% (10/793) of the cases with negative stump of bronchus (P < 0.01). The occurrence rate of BPF in the cases received preoperative radio- or chemotherapy was 5.0% (6/119), higher than 1.3% (9/696) of the cases received operation only (P < 0.05). There were no BPF occurred in the 76 cases whose bronchial stump were covered with autogenous tissues. All of the cases diagnosed as BPF were undertaken either closed or open chest drainage. Two cases were cured by thoracentesis aspiration and infusion antibiotics repeatedly. Two cases were cured by blocking the fistula with fibrin glue after sufficient anti-inflammatory treatment and hypertonic saline flushing. Six cases were discharged with a stable condition after closed drainage only. One case was discharged with open drainage for long time and 1 case was cured by hypertonic saline flushing after failure to cover the BPF using muscle flaps. Three cases died of multi-organs functional failure.
BPF are related to the bronchial stump management and positive or negative residue of tumor at the bronchial stump. Autogenous tissues covering of the bronchial stump is a effective method for decrease the rate of BPF and especially for those patients received preoperative radio- or chemotherapy and right pneumonectomy. It should be performed for early mild cases with repeated thoracentesis aspirations or blocking the fistula with fibrin glue together with antibiotics. Chest closed drainage immediately and flushing with hypertonic saline repeatedly are effective methods for BPF.
探讨肺切除术后支气管胸膜瘘（BPF）的治疗方法及预防原则。
回顾性分析1999年7月至2006年6月治疗的815例肺癌患者中15例肺切除术后BPF的临床资料。
右肺切除术后BPF发生率为3.9%（12/310），高于左肺切除术后的0.6%（3/505）（P<0.01）。支气管残端癌残留阳性患者的BPF发生率为22.7%（5/22），高于支气管残端阴性患者的1.3%（10/793）（P<0.01）。术前接受放疗或化疗患者的BPF发生率为5.0%（6/119），高于单纯接受手术患者的1.3%（9/696）（P<0.05）。76例支气管残端用自体组织覆盖的患者未发生BPF。所有诊断为BPF的患者均进行了闭式或开胸引流。2例经反复胸腔穿刺抽液及注入抗生素治愈。2例在充分抗炎治疗及高渗盐水冲洗后用纤维蛋白胶封堵瘘口治愈。6例仅经闭式引流后病情稳定出院。1例长期开胸引流出院，1例肌瓣覆盖BPF失败后经高渗盐水冲洗治愈。3例死于多器官功能衰竭。
BPF与支气管残端处理及支气管残端肿瘤残留阳性或阴性有关。支气管残端用自体组织覆盖是降低BPF发生率的有效方法，尤其适用于术前接受放疗或化疗及右肺切除的患者。对于早期轻症患者应尽早进行反复胸腔穿刺抽液或用纤维蛋白胶封堵瘘口并联合使用抗生素。立即进行胸腔闭式引流并反复用高渗盐水冲洗是治疗BPF的有效方法。
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