Cardillo Giuseppe, Carbone Luigi, Carleo Francesco, Galluccio Giovanni, Di Martino Marco, Giunti Roberto, Lucantoni Gabriele, Battistoni Paolo, Batzella Sandro, Dello Iacono Raffaele, Petrella Lea, Dusmet Michael
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
Ann Thorac Surg. 2015 Jul;100(1):251-7. doi: 10.1016/j.athoracsur.2015.03.014. Epub 2015 May 27.
Bronchopleural fistulas are a major therapeutic challenge. We have reviewed our experience to establish the best choice of treatment.
From January 2001 to December 2013, the records of 3,832 patients who underwent pulmonary anatomic resections were retrospectively reviewed.
The overall incidence of bronchopleural fistulas was 1.4% (52 of 3,832): 1.2% after lobectomy and 4.4% after pneumonectomy. Pneumonectomy vs lobectomy, right-sided vs left-sided resection, and hand-sewn closure of the stump vs stapling showed a statistically significant correlation with fistula formation. Primary bronchoscopic treatment was performed in 35 of 52 patients (67.3%) with a fistula of less than 1 cm and with a viable stump. The remaining 17 patients (32.7%) underwent primary operation. The fistula was cured with endoscopic treatment in 80% and with operative repair in 88.2%. Cure rates were 62.5% after pneumonectomy and 86.4% after lobectomy. The cure rate with endoscopic treatment was 92.3% in very small fistulas, 71.4% in small fistulas, and 80% in intermediate fistulas. The cure rate after surgical treatment was 100% in small fistulas, 75% in intermediate fistulas, and 100% in very large fistulas. Morbidity and mortality rates were 5.8% and 3.8%, respectively.
The bronchoscopic approach shows very promising results in all but the largest bronchopleural fistulas. Very small, small, and intermediate fistulas with a viable bronchial stump can be managed endoscopically, using mechanical abrasion, polidocanol sclerosing agent, and cyanoacrylate glue. Bronchoscopic treatment can be repeated, and if it fails, does not preclude subsequent successful surgical treatment.
支气管胸膜瘘是一个重大的治疗挑战。我们回顾了我们的经验以确定最佳治疗选择。
回顾性分析2001年1月至2013年12月期间3832例行肺解剖切除术患者的病历。
支气管胸膜瘘的总体发生率为1.4%（3832例中的52例）：肺叶切除术后为1.2%，全肺切除术后为4.4%。全肺切除术与肺叶切除术、右侧与左侧切除术以及残端手工缝合与吻合器缝合与瘘的形成具有统计学显著相关性。52例瘘口小于1cm且残端存活的患者中，35例（67.3%）接受了初次支气管镜治疗。其余17例患者（32.7%）接受了初次手术。80%的瘘通过内镜治疗治愈，88.2%通过手术修复治愈。全肺切除术后治愈率为62.5%，肺叶切除术后为86.4%。内镜治疗的治愈率在极小瘘为92.3%，小瘘为71.4%，中等瘘为80%。手术治疗后治愈率在小瘘为100%，中等瘘为75%，极大瘘为100%。发病率和死亡率分别为5.8%和3.8%。
除最大的支气管胸膜瘘外，支气管镜治疗方法显示出非常有前景的结果。对于极小、小和中等大小且支气管残端存活的瘘，可以使用机械磨蚀、聚多卡醇硬化剂和氰基丙烯酸酯胶进行内镜处理。支气管镜治疗可以重复进行，如果失败，并不排除随后成功的手术治疗。
