Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Thorac Cancer. 2022 May;13(9):1401-1405. doi: 10.1111/1759-7714.14404. Epub 2022 Apr 7.
The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success.
We retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity.
Twenty-five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07).
There was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.
本研究旨在探讨术后支气管胸膜瘘修复的结果，并确定影响其成功的不利因素。
我们回顾性分析了 2010 年 1 月至 2020 年 6 月期间 39 例接受手术修复的术后支气管胸膜瘘患者的手术结果。支气管胸膜瘘修复成功的定义为支气管胸膜瘘肉眼闭合，无空气泄漏，无支气管胸膜瘘复发和胸腔感染。
25 例（64.1%）支气管胸膜瘘发生在肺切除术后，14 例（35.9%）发生在肺移植术后。支气管胸膜瘘诊断于初始手术后 19 天（中位数），并于初始手术后 28 天（中位数）修复，其中 27 例（69.2%）患者行一期缝合，12 例（30.8%）患者行额外切除。总成功率为 59%（23/39），总死亡率为 56.4%（22/39）。多变量分析显示，修复时接受机械通气支持的患者成功率明显低于未接受机械通气支持的患者（15.4%，2/13 与 80.8%，21/26，分别，p < 0.001）。网膜瓣组的成功率有高于肌瓣组的趋势（p = 0.07）。
支气管胸膜瘘修复后总体死亡率高，成功率低。支气管胸膜瘘修复时的机械通气与支气管胸膜瘘修复失败显著相关。
