Pechetov A A, Gritsuta A Yu, Esakov Yu S, Lednev A N
Vishnevskiy Institute of Surgery of Ministry of Health of Russia, Moscow, Russia.
Khirurgiia (Mosk). 2019(7):5-9. doi: 10.17116/hirurgia20190715.
To present our experience in the treatment of patients with bronchopleural fistula and chronic non-specific pleural empyema after pneumonectomy.
There were 25 patients with chronic pleural empyema following bronchopleural fistula after pneumonectomy. All patients were examined in standard fashion and divided into two groups depending on length of bronchial stump: more or equal to 20 mm and less than 20 mm. Transsternal occlusion of bronchial stump was performed in the 1 group. Pedicled muscle or omental flap was applied for bronchial stump repair in the 2 group.
Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were grade daccording to Clavien-Dindo classification. Infectious complications not associated with bronchial stump insufficiency and required antibiotic therapy and/or topical treatment were registered in 6 (24%) out of 25 patients (95% CI 11.5-43.4): suppurative tracheobronchitis, pneumonia, postoperative wound suppuration in 1 (4%), 2 (8%) and 3 (12%) patients, respectively. Overall mortality rate was 2 (8%) out of 25 patients. There were no recurrences after transsternal occlusion of bronchial stump. In the control group, recurrent bronchopleural fistula was noted in 2 (12.5%) out of 16 patients (95% CI 3.5-36). Mean hospital-stay was 13 (13; 16) and 20 (11; 35) days in both groups, respectively (p<0.05). A good and satisfactory result after transsternal occlusion of bronchial stump was achieved in 23 (92%) out of 25 patients (95% CI 75-97.8).
Transsternal occlusion of bronchial stump is more advisable than tissue flap transposition in patients with chronic pleural empyema followed by BPF and bronchial stump length over 20 mm due to less trauma and good reproducibility.
介绍我们在治疗肺切除术后支气管胸膜瘘和慢性非特异性胸膜脓胸患者方面的经验。
25例肺切除术后支气管胸膜瘘合并慢性胸膜脓胸患者。所有患者均接受标准检查，并根据支气管残端长度分为两组：20mm及以上和小于20mm。第1组采用经胸骨封堵支气管残端。第2组采用带蒂肌肉或网膜瓣修复支气管残端。
随访时间为18至110个月（中位时间48（19；52）个月）。并发症根据Clavien-Dindo分类法分级。25例患者中有6例（24%）（95%CI 11.5-43.4）出现与支气管残端功能不全无关且需要抗生素治疗和/或局部治疗的感染性并发症：分别为1例（4%）患者发生化脓性气管支气管炎、2例（8%）患者发生肺炎、3例（%）患者发生术后伤口化脓。25例患者的总死亡率为2例（8%）。经胸骨封堵支气管残端后无复发。在对照组中，16例患者中有2例（12.5%）（95%CI 3.5-36）出现复发性支气管胸膜瘘。两组的平均住院时间分别为13（13；16）天和20（11；35）天（p<0.05）。25例患者中有23例（92%）（95%CI 75-97.8）经胸骨封堵支气管残端后取得了良好和满意的效果。
对于慢性胸膜脓胸合并支气管胸膜瘘且支气管残端长度超过20mm的患者，经胸骨封堵支气管残端比组织瓣移位更可取，因为其创伤较小且可重复性好。
