Shirakusa T, Ueda H, Takata S, Yoneda S, Inutsuka K, Hirota N, Okazaki M
Second Department of Surgery, School of Medicine, Fukuoka University, Japan.
Ann Thorac Surg. 1990 Sep;50(3):420-4. doi: 10.1016/0003-4975(90)90487-q.
Omental pedicle flaps were used in the treatment of patients with acute and chronic empyema with bronchopleural fistula. In 5 patients (group 1) with postoperative acute empyema owing to bronchial stump fistula, an omental covering was applied as a reinforcement to close the fistula. Six patients in group 2 with chronic tuberculous or Aspergillus empyema with multiple fistulas initially underwent open-window thoracostomy or cavernostomy and secondarily had omental transposition. In all patients, the right gastroepiploic vessels were used to provide the blood supply for the flap. Successful closure of the bronchial stump was obtained in all patients in group 1, but 2 of them died of recurrence of their underlying lung carcinoma within 1 year. Five of the 7 patients in group 2 had a favorable outcome, but 2 patients had partial recurrence after omental plombage. From our experience with these patients, we believe that the omental flap is effective for closing fistulas due to postoperative or chronic empyema but has only limited success in patients whose lungs are severely damaged by persistent infection.
网膜蒂皮瓣用于治疗急性和慢性脓胸合并支气管胸膜瘘的患者。在5例（第1组）因支气管残端瘘导致术后急性脓胸的患者中，应用网膜覆盖作为加强措施以闭合瘘口。第2组6例患有慢性结核性或曲霉菌性脓胸且有多个瘘口的患者，最初接受了开窗胸廓成形术或空洞造口术，随后进行了网膜移位术。在所有患者中，均采用右胃网膜血管为皮瓣提供血供。第1组所有患者的支气管残端均成功闭合，但其中2例在1年内死于原发性肺癌复发。第2组7例患者中有5例预后良好，但2例在网膜填充后出现部分复发。根据我们对这些患者的经验，我们认为网膜瓣对于闭合术后或慢性脓胸引起的瘘口是有效的，但对于肺部因持续感染而严重受损的患者，其成功率有限。
