右中下肺叶切除术治疗右下肺叶切除术后支气管胸膜瘘——一种被忽视的方法。

Treat bronchopleural fistula after right lower lobectomy by extra right middle lobectomy-a neglected approach.

机构信息

Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Thoracic Surgery, Xiangya Hospital of Central South University, Hunan, China.

出版信息

Interact Cardiovasc Thorac Surg. 2020 Jul 1;31(1):63-70. doi: 10.1093/icvts/ivaa050.

DOI:10.1093/icvts/ivaa050

PMID:32259254

Abstract

OBJECTIVES

Bronchopleural fistula (BPF) after right lower lobectomy (RLL), although uncommon, is associated with high mortality rates. This study was aimed at evaluating the therapeutic effect of extra right middle lobectomy (ERML) in the management of BPF after RLL.

METHODS

We investigated 12 consecutive patients who were treated at our hospital for BPF occurring after RLL. The diagnosis of BPF was established by bronchoscopy in all cases and BPFs were treated by ERML. All patients were followed up for at least 1 year after ERML to assess treatment outcomes.

RESULTS

The severity of infection and malnutrition after BPF was different for different patients. All patients agreed to undergo ERML. The procedure was uneventful in all cases, and there were no cases of perioperative complications or death. The median duration of hospitalization after ERML was 10.5 (range 6-21) days. Postoperative pathological examination showed the presence of hyperaemia and oedema in the BPF stump, and inflammatory cell infiltration in the stroma. The fresh stump of the bronchus intermedius was well structured. Patients were followed up for a median duration of 27 (range 12-41) months. The BPFs were successfully treated in all patients, and a new BPF did not develop in the new fresh stump in any of the cases.

CONCLUSIONS

ERML aimed at creating a fresh stump for quick healing could be alternative for treating BPF after RLL.

摘要

目的

右肺下叶切除术（RLL）后发生支气管胸膜瘘（BPF）虽然少见，但与高死亡率相关。本研究旨在评估右中肺叶切除术（ERML）在治疗 RLL 后 BPF 中的治疗效果。

方法

我们调查了在我院接受治疗的 12 例 RLL 后发生 BPF 的连续患者。所有病例均通过支气管镜确诊为 BPF，并采用 ERML 治疗 BPF。所有患者在 ERML 后至少随访 1 年，以评估治疗结果。

结果

不同患者 BPF 后感染和营养不良的严重程度不同。所有患者均同意接受 ERML。所有病例手术均顺利，无围手术期并发症或死亡病例。ERML 后住院时间中位数为 10.5 天（范围 6-21 天）。术后病理检查显示 BPF 残端存在充血和水肿，基质中有炎症细胞浸润。中间支气管的新鲜残端结构良好。患者平均随访 27 个月（范围 12-41 个月）。所有患者均成功治愈 BPF，新的新鲜残端均未发生新的 BPF。