Honda Yohei, Taira Akihiro, Hirai Ayako, Kuroda Koji, Ichiki Yoshinobu, Tanaka Fumihiro
Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Department of Thoracic Surgery, Shimonoseki City Hospital, 1 Chome-13-1 Koyocho, Shimonoseki, Yamaguchi, 750-0041, Japan.
Surg Case Rep. 2020 Jul 29;6(1):183. doi: 10.1186/s40792-020-00908-8.
Post-esophagectomy bronchopleural fistulas can be life-threatening in patients who are exhausted, for example, by surgical stress and pleural infection; therefore, establishment of a reliable surgical procedure is extremely important. We here report a novel procedure entailing muscle flap closure for bronchopleural fistula.
A 64-year-old man developed a right bronchopleural fistula after esophagectomy. Because he was exhausted by surgical stress and malnourished, we considered reliable surgical closure of the fistula essential. Intraoperatively, it was found to connect with the membranous portion of the right main bronchus. We decided to close the fistula with a pedicled fourth and fifth intercostal muscle flap. After separating the intercostal muscles near the angle of the rib, we passed a muscle flap between the azygos vein and bronchus and sutured it securely to the fistula. The postoperative course was uneventful, and there was no thoracic infection. Postoperative bronchoscopy confirmed the muscle flap had securely closed the fistula.
The route and suturing technique of the intercostal muscle flap to a fistula are important, especially in exhausted patients.
食管切除术后支气管胸膜瘘对于例如因手术应激和胸膜感染而身体虚弱的患者可能危及生命；因此，建立一种可靠的手术方法极其重要。我们在此报告一种采用肌瓣闭合支气管胸膜瘘的新方法。
一名64岁男性在食管切除术后发生右支气管胸膜瘘。由于他因手术应激而身体虚弱且营养不良，我们认为可靠地手术闭合瘘口至关重要。术中发现瘘口与右主支气管膜部相连。我们决定用带蒂的第四和第五肋间肌瓣闭合瘘口。在肋骨角附近分离肋间肌后，我们将一块肌瓣置于奇静脉和支气管之间并牢固地缝合至瘘口。术后过程顺利，无胸腔感染。术后支气管镜检查证实肌瓣已牢固闭合瘘口。
肋间肌瓣至瘘口的路径和缝合技术很重要，尤其是对于身体虚弱的患者。
