胸膜内和支气管内联合注射纤维蛋白胶封闭肺泡胸膜瘘：病例报告
Combined intrapleural and intrabronchial injection of fibrin glue for closing alveolar pleural fistula: a case report.
作者信息
Fiorelli Alfonso, Odierna Italia, Scarano Daniele, Caronia Francesco, Failla Andrea, Iannotti Mario, Santini Mario, Pace Caterina
机构信息
Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, I-80138, Naples, Italy.
Anaesthesiology and Intensive Care Unit, Umberto I Hospital, Nocera Inferiore, Salerno, Italy.
出版信息
J Cardiothorac Surg. 2019 Sep 18;14(1):171. doi: 10.1186/s13019-019-0987-7.
BACKGROUND
The treatment of persistent air leak is a challenge. Herein, we reported the combined intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy to seal off an alveolar pleura fistula developed following necrotizing pneumonia in high-risk patient.
CASE PRESENTATION
A 74-year-old man was intubated in emergency for acute ischemic stroke. Percutaneous dilatational tracheostomy was then performed, and 15 days later patient returned to spontaneous breathing. However, he developed alveolar pleural fistula following necrotizing pneumonia with persistent air leaks. The intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy sealed off the alveolar pleura fistula after that other endoscopic treatments as bronchial valve and intrabronchial fibrin glue application had failed.
CONCLUSIONS
Our strategy is safe and easy to reproduce. It represents an additional method in the armamentarium of the physicians for the management of PAL when all standard strategies are unfeasible or fail.
背景
持续性气胸漏气的治疗是一项挑战。在此，我们报告了在高危患者中，使用纤维支气管镜经支气管和经胸膜联合注射纤维蛋白胶来封闭坏死性肺炎后形成的肺泡胸膜瘘。
病例介绍
一名74岁男性因急性缺血性卒中在急诊插管。随后进行了经皮扩张气管切开术，15天后患者恢复自主呼吸。然而，他在坏死性肺炎后出现肺泡胸膜瘘并伴有持续性气胸漏气。在支气管瓣膜和支气管内应用纤维蛋白胶等其他内镜治疗失败后，使用纤维支气管镜经支气管和经胸膜联合注射纤维蛋白胶封闭了肺泡胸膜瘘。
结论
我们的策略安全且易于重复。当所有标准策略均不可行或失败时，它为医生处理肺泡胸膜瘘提供了一种额外的方法。
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