Leuzzi Giovanni, Alessandrini Gabriele, Forcella Daniele, Facciolo Francesco
Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Interact Cardiovasc Thorac Surg. 2015 May;20(5):672-4. doi: 10.1093/icvts/ivu450. Epub 2015 Jan 23.
In the literature, bronchopleural fistula after thoracic surgery is usually reported in the perioperative setting; however, the incidence of delayed fistula still remains unknown. We herein report a case of a 54-year old man who was referred to the Emergency Department for dyspnoea and productive cough with expectoration of a whitish 'suture-like' tissue. Two months before, the patient underwent an uneventful right lower lobectomy for squamous-cell lung cancer. A computed tomography scan revealed a para-mediastinal localized pneumothorax (measuring 6 cm in the major axis) starting from a right lower bronchus interruption associated with a middle lobe consolidation. The patient was consequently admitted for respiratory monitoring and underwent a fibre-optic bronchoscopy to assess bronchial integrity: the right lower bronchus was completely dehiscent and connected to an empty pleural closed pouch, with no inflammatory signs or sputum-like effusion. After the procedure, the clinical course was unremarkable with gradual improvement of clinical conditions: in particular, the cough disappeared and no sign of fever, leucocytosis or respiratory failure was observed. Thus, after a multidisciplinary meeting, the patient was discharged 7 days after admission and re-evaluated monthly. Six months after diagnosis, the patient was symptom-free with complete closure of the fistula on radiological imaging.
在文献中，胸外科手术后的支气管胸膜瘘通常在围手术期被报道；然而，迟发性瘘的发生率仍然未知。我们在此报告一例54岁男性患者，他因呼吸困难和咳出白色“缝线样”组织的咳痰而被转诊至急诊科。两个月前，该患者因鳞状细胞肺癌接受了顺利的右下肺叶切除术。计算机断层扫描显示，从右下支气管中断处开始出现一个纵隔旁局限性气胸（长轴为6厘米），伴有中叶实变。因此，患者入院接受呼吸监测，并接受了纤维支气管镜检查以评估支气管的完整性：右下支气管完全裂开，与一个空的胸膜封闭腔隙相连，没有炎症迹象或痰液样渗出物。术后，临床过程平稳，临床状况逐渐改善：特别是咳嗽消失，未观察到发热、白细胞增多或呼吸衰竭的迹象。因此，经过多学科会诊，患者在入院7天后出院，每月进行重新评估。诊断后6个月，患者无症状，影像学检查显示瘘完全闭合。
