Department of Thoracic Surgery, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
Eur J Cardiothorac Surg. 2010 Jan;37(1):40-3. doi: 10.1016/j.ejcts.2009.07.006. Epub 2009 Aug 21.
Postoperative bronchopleural fistula (BPF) is a serious complication and a therapeutic challenge in thoracic surgery. The purpose of this study is to assess the efficacy of the use of the silver-human albumin (SHA) complex injected in the bronchial submucosa for the treatment of BPF.
From January 2005 to March 2008, we treated 11 patients with BPF (seven post-pneumonectomy and four post-lobectomy) by endoscopic injection of the SHA complex into the bronchial submucosa. In all patients a chest drain was positioned and employed for antibiotic pleural irrigation. Simultaneously, the endoscopic treatment including repeated injection of the SHA complex was started. In 10 patients the diameter of the fistulas was equal to or smaller than 5mm (range: 3-5mm) and in one it was larger than 5mm (8mm).
There was no morbidity or mortality related to the procedure. Permanent closure of the fistula was achieved in all 10 patients with a BPF of 3-5mm. In four of these patients (post-lobectomy fistula), the good general condition allowed early discharge with the Heimlich valve before the completion of treatment. Two other patients with a fistula smaller than 5mm presented persisting empyema and compromised general conditions after closure of the post-pneumonectomy BPF. These patients underwent fast-track treatment of the empyema achieving definitive cure. In the patient with a BPF larger than 5mm, the conservative treatment was not sufficient and an omental flap transposition was necessary.
The SHA complex submucosal injection is easy, safe and inexpensive. It can be considered a valid therapeutic option in selected patients presenting an early fistula with a size equal to or smaller than 5mm. Early diagnosis, simultaneous insertion of a chest drain and achievement of a sterile pleural cavity are fundamental conditions for the final success of the procedure.
术后支气管胸膜瘘（BPF）是胸外科的一种严重并发症和治疗挑战。本研究旨在评估将银-人白蛋白（SHA）复合物注入支气管黏膜下层治疗 BPF 的疗效。
从 2005 年 1 月至 2008 年 3 月，我们通过内镜将 SHA 复合物注入支气管黏膜下层治疗 11 例 BPF 患者（7 例肺切除术后，4 例肺叶切除术后）。所有患者均放置胸腔引流管，并进行抗生素性胸腔灌洗。同时，开始进行内镜治疗，包括重复注射 SHA 复合物。在 10 例患者中，瘘管直径等于或小于 5mm（范围：3-5mm），1 例大于 5mm（8mm）。
该操作无相关发病率或死亡率。10 例直径为 3-5mm 的 BPF 患者瘘口均永久闭合。在这 4 例肺叶切除术后瘘患者中，良好的一般状况允许在完成治疗前，通过 Heimlich 阀提前出院。另外 2 例瘘口小于 5mm 的患者在肺切除术后 BPF 闭合后出现持续脓胸和一般状况恶化。这些患者接受了脓胸的快速通道治疗，最终治愈。对于瘘口大于 5mm 的患者，保守治疗不够，需要进行带蒂网膜瓣转移。
SHA 复合物黏膜下注射操作简单、安全、经济。对于早期瘘口大小等于或小于 5mm 的患者，可将其视为一种有效的治疗选择。早期诊断、同时插入胸腔引流管并使胸腔无菌是该操作最终成功的基本条件。
