Shi Zhenliang, Xu Yijun, Wang Zheng, Zhang Xun
Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China.
J Thorac Dis. 2017 Apr;9(4):E358-E363. doi: 10.21037/jtd.2017.03.69.
One case of successful primary closure of a bronchopleural fistula (BPF) after right pneumonectomy by sealing from both inside the chest cavity and bronchus is reported. The patient was a 47-year-old man who underwent right pneumonectomy due to right lung total collapse and atelectasis which was long-term compressed by a huge cyst inside the right chest cavity. A BPF was found on day 20 after surgery. A thoracotomy approach was performed because it was difficult to find an appropriate location for close drainage. Once the effusion and bloody coagulum was cleaned up from the right chest cavity, it was still difficult to find the bronchial stump because of the thick pleural fibrous membranes, and no visible fistula was found. Inside the chest cavity, a bright spot could be seen when the bronchoscope was inserted to the right bronchial stump. Anastomotic glue (OB Glue) was smeared on the bright spot and NEOVEIL (Gunze Co., Tokyo, Japan) was used to cover and reinforce the area. Meanwhile OB Glue (Gzbme Co., Guangzhou, China) was placed on the bronchial stump by bronchoscope. Closed drainage was performed after the operation. The patient recovered well having an uncomplicated postoperative course and was discharged 7 days after the treatment.
报道了1例右肺切除术后通过胸腔内和支气管内封堵成功实现支气管胸膜瘘（BPF）一期闭合的病例。患者为47岁男性，因右肺完全萎陷及肺不张接受右肺切除术，右肺长期受右胸腔内巨大囊肿压迫。术后第20天发现BPF。因难以找到合适的闭式引流位置，故行开胸手术。清除右胸腔内的积液和血凝块后，由于胸膜纤维膜增厚，仍难以找到支气管残端，未发现明显瘘口。在胸腔内，将支气管镜插入右支气管残端时可见一亮点。在亮点处涂抹吻合胶（OB胶），并用NEOVEIL（日本东京郡是株式会社）覆盖并加固该区域。同时，通过支气管镜将OB胶（中国广州倍绣生物技术有限公司）置于支气管残端。术后行闭式引流。患者术后恢复良好，无并发症，治疗后7天出院。
