Cooper Medical School, Rowan University, Camden, NJ, USA.
Cooper Medical School, Rowan University, 3 Cooper Plaza, Suite 312, Camden, NJ 08103, USA.
Ther Adv Respir Dis. 2021 Jan-Dec;15:17534666211044411. doi: 10.1177/17534666211044411.
Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus 21-gauge EBUS-TBNA (endobronchial ultrasound-transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.
支气管胸膜瘘（BPF）导致持续性肺漏气（PAL），无论是肺部切除术后、放疗还是直接肿瘤压迫的并发症，都会导致高发病率、生活质量受损和死亡风险增加。肺切除术后 BPF 的发生率在 4.4%至 20%之间，死亡率在 27.2%至 71%之间。在报道的系列中，肺叶切除术后的发生率为 0.5%至 1.5%。右侧肺切除术后 BPF 更易发生，而双肺叶切除术患者比单肺叶切除术患者更容易发生 BPF。除了包括适当的抗生素和营养在内的支持性治疗外，BPF 的治疗还包括胸膜清创、BPF 闭合以及最终使胸膜腔闭塞。BPF 的管理包括手术和支气管镜方法。手术干预最适合于大型 BPF 和术后早期发生的 BPF。支气管镜技术可用于较小的 BPF 或当个体患者不再适合手术时。已有文献报道使用聚乙二醇、纤维蛋白胶、自体血液制品、明胶海绵、硝酸银和支架等技术。Amplatzer 装置，用于关闭房间隔缺损，作为一种支气管镜治疗方法显示出前景。在人道主义器械豁免计划下获得批准用于治疗持续性肺漏气后，支气管内瓣膜已用于 BPF。没有一种支气管镜技术是普遍适用的，治疗应该个体化。在本报告中，我们描述了两个单独的病例，我们使用 Olympus 21 号 EBUS-TBNA（支气管内超声-经支气管针吸活检）针进行定向黏膜下注射乙醇，导致 BPF 闭合，随后成功解决 PAL。
