Pulmonary Institute, Rabin Medical Center, Petah Tiqwa.
Pulmonary Institute, Rabin Medical Center, Petah Tiqwa.
Chest. 2011 Mar;139(3):682-687. doi: 10.1378/chest.10-1528.
Bronchopulmonary fistulae (BPFs) are a severe complication of lobectomy and pneumonectomy and are associated with high rates of morbidity and mortality. We have developed a novel, minimally invasive method of central BPF closure using Amplatzer devices (ADs) that were originally designed for the transcatheter closure of cardiac defects. Ten patients with 11 BPFs (eight men and two women, aged 66.3±10.1 years [mean±SD]) were treated under conscious sedation with bronchoscopic closure of the BPFs using ADs. A nitinol double-disk occluder device was delivered under direct bronchoscopic guidance over a guidewire into the fistula. By extruding a disk on either side of the BPF, the fistula was occluded. Bronchography was performed by injecting contrast medium through the delivery sheath following the procedure to ensure correct device positioning. In nine patients, the procedure was successful and symptoms related to the BPF disappeared following closure by the AD. The results were maintained over a median follow-up period of 9 months. Therefore, we state that endobronchial closure using an AD is a safe and effective method for treatment of a postoperative BPF.
支气管胸膜瘘（BPF）是肺叶切除术和全肺切除术的严重并发症，与高发病率和死亡率相关。我们开发了一种使用 Amplatzer 装置（AD）治疗中央 BPF 的新型微创方法，该装置最初用于经导管心脏缺陷的封堵。10 名患者（8 名男性，2 名女性，年龄 66.3±10.1 岁[均值±标准差]）在清醒镇静下接受支气管镜下使用 AD 治疗 BPF。在支气管镜引导下，将镍钛双盘封堵器输送器沿导丝送入瘘管。通过将一个圆盘从 BPF 的两侧推出，将瘘管闭塞。在手术完成后，通过输送鞘注射造影剂进行支气管造影，以确保正确的器械定位。在 9 例患者中，该手术成功，AD 封堵后与 BPF 相关的症状消失。中位随访 9 个月时，结果保持稳定。因此，我们认为使用 AD 进行支气管内封堵是治疗术后 BPF 的一种安全有效的方法。
