Chen Yun, Peng Xiong, Wang Yanqing, Zhou Yuan, Xia Kun, Zhuang Wei
Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 Oct 28;42(10):1163-1168. doi: 10.11817/j.issn.1672-7347.2017.10.006.
To explore the risk factors, preventive measures and therapeutic methods for bronchopleural fistula (BPF) after lung resections. Methods: A restrospective analysis for 11 patients with BPF after pneumonectomy from April 2012 to June 2016 in Department of Thoracic Surgery, Xiangya Hospital, Central South University was performed. Their clinical characteristics, treatment and prognosis were analyzed, and the risk factors and effective therapeutic strategies were summarized. Results: Among the 11 patients with BPF, 10 cases were cured finally, and 1 case with conservative treatment was dead. The total mortality rate was 9.09%. The 10 patients treated with positive measures were all cured, including 5 cases with pulmonary lobectomy and pneumonectomy, 4 cases with amplatzer and covered stent, and 1 case with fibrin glue. One case with conservative treatment was dead because of respiratory failure. Conclusion: It is important to intervene BPF as early as possible. Fibrin glue via bronchoscope for tiny BPF after lung resection is preferred to be considered. We recommend to take early positive operation (pulmonary lobectomy and pneumonectomy) after pulmonary resection if the BPF cannot be cured via bronchoscope whereas the patients' condition is allowed. The amplatzer or covered stent should be considered first for the patient with BPF after pneumonectomy.
探讨肺切除术后支气管胸膜瘘（BPF）的危险因素、预防措施及治疗方法。方法：对中南大学湘雅医院胸外科2012年4月至2016年6月间11例肺切除术后发生BPF的患者进行回顾性分析。分析其临床特征、治疗及预后情况，总结危险因素及有效的治疗策略。结果：11例BPF患者中，最终10例治愈，1例保守治疗死亡，总死亡率为9.09%。10例采取积极措施治疗的患者均治愈，其中5例行肺叶切除及全肺切除术，4例行Amplatzer封堵器及带膜支架置入术，1例行纤维蛋白胶封堵术。1例保守治疗患者因呼吸衰竭死亡。结论：尽早干预BPF很重要。肺切除术后微小BPF首选经支气管镜注入纤维蛋白胶治疗。若经支气管镜无法治愈且患者病情允许，建议肺切除术后尽早采取积极手术（肺叶切除及全肺切除术）。对于全肺切除术后发生BPF的患者应首先考虑置入Amplatzer封堵器或带膜支架。
