Eckersberger F, Moritz E, Klepetko W, Müller M R, Wolner E
II. Surgical Department, University of Vienna, Austria.
Thorac Cardiovasc Surg. 1990 Dec;38(6):352-4. doi: 10.1055/s-2007-1014048.
Postpneumonectomy empyema with or without (bronchopleural) fistula is an infrequent but serious, and often life-threatening complication. In 20 of our patients postpneumonectomy empyema was discovered. The time interval between original operation and discovery of the empyema varied from 9 days to 9 years. In two cases, the empyema had been found and treated initially at another hospital but not adequately, so that at the time of treatment by us the bronchopleural fistula had already been present for 8 and 19 years. In 13 cases a bronchial stump fistula was discovered. In five patients the fistula was successfully closed endoscopically with glue. In one patient closure was performed by transmediastinal stump resection, in three patients with a fistula thoracoplasty was performed. In three patients we achieved closure by transposition of pedicled muscle flaps. In one of these patients a septic condition could be mastered by performing window thoracotomy. Two patients without fistula were successfully treated with irrigation, and two further patients with thoracostomy. In one patient recovery was achieved by medication after puncture. Two patients died of sepsis and after thoracoplasty. If a fistula is present, drainage with irrigation and endoscopical glueing should be the initial treatment. This should be followed by resection of the bronchial stump. If there is no fistula or if the stump is too short thoracostomy is the treatment of choice. If it is not successful thoracoplasty has to be performed.
肺切除术后脓胸伴或不伴（支气管胸膜）瘘是一种罕见但严重且常危及生命的并发症。我们的20例患者发现了肺切除术后脓胸。从最初手术到发现脓胸的时间间隔从9天到9年不等。在2例患者中，脓胸最初在另一家医院被发现并接受治疗，但治疗不充分，以至于在我们治疗时支气管胸膜瘘已经存在8年和19年。在13例患者中发现了支气管残端瘘。5例患者通过内镜用胶水成功封闭了瘘口。1例患者通过经纵隔残端切除术进行了封闭，3例有瘘的患者进行了胸廓成形术。3例患者通过带蒂肌瓣转移实现了封闭。其中1例患者通过开胸开窗术控制了感染。2例无瘘的患者通过冲洗成功治疗，另外2例患者进行了胸廓造口术。1例患者穿刺后通过药物治疗康复。2例患者死于败血症和胸廓成形术后。如果存在瘘，初始治疗应为冲洗引流和内镜下粘堵。随后应进行支气管残端切除术。如果没有瘘或残端过短，胸廓造口术是首选治疗方法。如果不成功，则必须进行胸廓成形术。
