采用包括支气管封堵器和栓塞术在内的综合方法，并接受静脉-静脉体外膜肺氧合治疗，成功治愈了伴有瘘管的脓胸。
Empyema with fistula successfully treated with a comprehensive approach including bronchial blocker and embolization receiving veno-venous extracorporeal membrane oxygenation.
作者信息
Shin Kijong, Hifumi Toru, Tsugitomi Ryosuke, Isokawa Shutaro, Shimizu Masato, Otani Norio, Ishimatsu Shinichi
机构信息
Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan.
Department of Thoracic Medical Oncology The Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan.
出版信息
Acute Med Surg. 2021 Feb 9;8(1):e621. doi: 10.1002/ams2.621. eCollection 2021 Jan-Dec.
BACKGROUND
Complicated empyema accompanied by bronchopleural fistula (BPF) has high mortality. The treatment strategy for severe respiratory failure due to empyema with BPF has yet to be established.
CASE PRESENTATION
A 70-year-old man was brought to our hospital and diagnosed with right empyema, BPF (at bronchi B4-10), and secondary left pneumonia. We initiated drainage followed by veno-venous extracorporeal membrane oxygenation due to the severe hypoxia. First, the patient underwent endoscopic treatment with obstructive materials (known as endobronchial Watanabe spigot [EWS]) at B8-10, and was weaned off veno-venous extracorporeal membrane oxygenation on day 7. A secondary EWS was carried out at B4-6. A combination of medical treatments (drainage, antibiotics, nutritional therapy, and rehabilitation) improved his general condition. The patient was able to leave the hospital on foot.
CONCLUSION
A comprehensive approach could explain the success of the medical treatment. The principal components are the repeated application of EWS as damage control.
背景
伴有支气管胸膜瘘（BPF）的复杂性脓胸死亡率很高。伴有BPF的脓胸所致严重呼吸衰竭的治疗策略尚未确立。
病例报告
一名70岁男性被送至我院，诊断为右侧脓胸、BPF（位于支气管B4 - 10）及继发性左侧肺炎。由于严重缺氧，我们首先进行了引流，随后进行了静脉 - 静脉体外膜肺氧合。首先，患者在B8 - 10接受了阻塞材料的内镜治疗（即支气管内渡边栓子[EWS]），并于第7天撤下静脉 - 静脉体外膜肺氧合。在B4 - 6进行了二次EWS。综合治疗（引流、抗生素、营养治疗和康复）改善了他的总体状况。患者能够步行出院。
结论
综合治疗方法可以解释治疗成功的原因。主要组成部分是重复应用EWS作为损伤控制。
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