Hoffmann E, Jankowski J, Lersmacher J, Kantartzis M
Chirurgische Abteilung, St. Josef Krankenhaus, Universität Düsseldorf, Wuppertal.
Langenbecks Arch Chir. 1990;375(1):46-50. doi: 10.1007/BF00186120.
Insufficiency of the bronchial stump is still a dreaded complication. The treatment with the use of extrapleural accesses led to a significant improvement of the therapeutical results. We have to distinguish between transpericardial techniques and the contralateral thoracotomy with transpleural or extrapleural access. If the pleural cavity is still sterile, immediate or four week postoperative insufficiency may be treated using rethoracotomy with resuturing the stump. Coverage of the stump with pedicled muscle tissue provides a rather good method for a secondary treatment of the bronchial stump. When the pleural cavity is already infected, extrapleural treatment of the bronchial stump should be undertaken immediately. In addition, all late insufficiencies are treated extrapleurally. If only a very small opening of a fistula is found, an endoscopical closure of the fistula should be attempted using acryl glue or fibrin glue. Our own therapeutic results concerning four right hand and one left hand stump insufficiency after pneumonectomy are presented in this study and we have classified the up to now published therapeutical results.
支气管残端闭合不全仍是一种可怕的并发症。采用经胸壁外入路进行治疗使治疗效果有了显著改善。我们必须区分经心包技术以及经胸腔或胸壁外入路的对侧开胸手术。如果胸腔仍无菌，对于术后即刻或四周出现的闭合不全，可通过再次开胸重新缝合残端进行治疗。带蒂肌肉组织覆盖残端为支气管残端的二期治疗提供了一种相当不错的方法。当胸腔已被感染时，应立即对支气管残端进行胸壁外治疗。此外，所有晚期闭合不全均采用胸壁外治疗。如果仅发现瘘口非常小，应尝试使用丙烯酸胶或纤维蛋白胶通过内镜闭合瘘口。本研究展示了我们自身关于肺切除术后四例右侧和一例左侧残端闭合不全的治疗结果，并且我们对目前已发表的治疗结果进行了分类。
