Li Xiaoyun, Deng Hanyu, Zheng Xi, Zhu Daxing, Zhou Qinghua, Tang Xiaojun
Southwest Medical University, Luzhou 646000, China.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 611135, China.
Zhongguo Fei Ai Za Zhi. 2020 May 20;23(5):360-364. doi: 10.3779/j.issn.1009-3419.2020.104.01.
Bronchial sleeve lobectomy is essential surgical approach to treat centralized lung cancer. It is the best reflected the principle of lung cancer surgery, "remove tumor completely while minimize pulmonary function loss". Bronchial pleural fistula (BPF) is not common but very severe complication of bronchial sleeve lobectomy, that is usually fatal. Present article is to explore clinical effect on prevention of bronchial pleural fistula (BPF) in bronchial sleeve lobectomy, by wrapping brachial anastomosis with pedicled pericardial fat flap.
Clinical data of 39 non-small cell lung cancer (NSCLC) patients who underwent surgical resection during January 2016 to May 2019 in Lung Cancer Center of West China Hospital, Sichuan University were collected and retrospectively analyzed. All of the patients underwent bronchial sleeve lobectomy and a brachial anastomosis wrapping with pedicled pericardial fat flap.
All patients recovered well and were discharged within 6 d-14 d after operation. No BPF occurred, nor other severe complications, such as reoperation needing intrathoracic bleeding, several pneumonia and respiratory failure, and life threatening cardiac arrhythmia. Only one patient (1/39) had several anastomotic stenosis and consequential atelectasis of residual lung in operative side 6 months after surgery.
Wrapping bronchial anastomosis with pedicled pericardial fat flap in bronchial lobectomy for centralized NSCLC is a simple and effective approach to prevent BPF, thus safety of the operation could be significantly improved.
支气管袖状肺叶切除术是治疗中央型肺癌的重要手术方式。它最能体现肺癌手术的原则，即“在最大限度减少肺功能损失的同时彻底切除肿瘤”。支气管胸膜瘘（BPF）是支气管袖状肺叶切除术并不常见但非常严重的并发症，通常是致命的。本文旨在探讨带蒂心包脂肪瓣包裹支气管吻合口对预防支气管袖状肺叶切除术中支气管胸膜瘘（BPF）的临床效果。
收集并回顾性分析2016年1月至2019年5月在四川大学华西医院肺癌中心接受手术切除的39例非小细胞肺癌（NSCLC）患者的临床资料。所有患者均接受了支气管袖状肺叶切除术及带蒂心包脂肪瓣包裹支气管吻合口。
所有患者恢复良好，术后6天至14天内出院。未发生BPF，也未出现其他严重并发症，如需要再次手术的胸腔内出血、严重肺炎和呼吸衰竭以及危及生命的心律失常。仅1例患者（1/39）术后6个月出现吻合口轻度狭窄及术侧残余肺叶肺不张。
在中央型NSCLC支气管肺叶切除术中采用带蒂心包脂肪瓣包裹支气管吻合口是预防BPF的一种简单有效的方法，可显著提高手术安全性。
