Ferraroli Giorgio Maria, Perroni Gianluca, Giudici Veronica Maria, Antonicelli Alberto, Fernando Hiran Chrishantha, Ambrogi Vincenzo, Alloisio Marco, Voulaz Emanuele, Bottoni Edoardo, Infante Maurizio Valentino, Testori Alberto
Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.
Department of Thoracic Surgery, Tor Vergata University, 00133 Rome, Italy.
J Clin Med. 2022 Mar 30;11(7):1934. doi: 10.3390/jcm11071934.
Background Persistent air leak is a common complication after lung resection causing prolonged length of stay and increased healthcare costs. Surgical intervention can be an option, but other more conservative approaches should be considered first. Here, we describe the use of flexible bronchoscopy to apply fibrin glue and autologous blood sequentially to the damaged lung. We named the technique "flexible thoracoscopy".
Medical records from patients with persistent air leaks after lung resection were collected retrospectively. Depending on the type of aerostasis that was performed, two groups were created: flexible thoracoscopy and surgery (thoracotomy). Flexible thoracoscopy was introduced at our institution in 2013. We entered the pleural space with a bronchoscope following the same surgical pathway that was used for tube thoracostomy. Perioperative characteristics and outcomes were analyzed using R software (ver. 3.4.4).
From 1997 to 2021, a total of 23 patients required an intervention for persistent air leaks. Aerostasis was performed via flexible thoracoscopy in seventeen patients (69%) and via thoracotomy in six patients (31%). The median age was 70 years (22-82). Twenty patients were males (87%). There was no difference in age, sex distribution, BMI, comorbidities and FEV1%. An ASA score of 3 was more represented in the flexible thoracoscopy group; however, no evidence of a difference was found when compared to the thoracotomy group ( = 0.124). Length of in-hospital stay and chest tube duration was also similar between groups ( = 1 and = 0.68, respectively).
Aerostasis achieved either by flexible thoracoscopy or by thoracotomy showed similar results. We believe that flexible thoracoscopy could be a valid alternative to facilitate minimally invasive treatments for persistent air leaks. Further studies are needed to confirm these results.
背景 持续性漏气是肺切除术后常见的并发症，会导致住院时间延长和医疗费用增加。手术干预是一种选择，但应首先考虑其他更保守的方法。在此，我们描述了使用可弯曲支气管镜依次向受损肺应用纤维蛋白胶和自体血的方法。我们将该技术命名为“可弯曲胸腔镜检查”。
回顾性收集肺切除术后持续性漏气患者的病历。根据所进行的肺固定术类型，分为两组：可弯曲胸腔镜检查组和手术组（开胸手术）。可弯曲胸腔镜检查于2013年在我们机构引入。我们通过与胸腔闭式引流相同的手术路径，用支气管镜进入胸膜腔。使用R软件（版本3.4.4）分析围手术期特征和结果。
1997年至2021年，共有23例患者因持续性漏气需要干预。17例患者（69%）通过可弯曲胸腔镜检查进行肺固定术，6例患者（31%）通过开胸手术进行。中位年龄为70岁（22 - 82岁）。20例患者为男性（87%）。年龄、性别分布、体重指数、合并症和第1秒用力呼气量百分比无差异。可弯曲胸腔镜检查组中美国麻醉医师协会（ASA）评分为3分的患者更多；然而，与开胸手术组相比，未发现差异有统计学意义（P = 0.124）。两组的住院时间和胸管留置时间也相似（P = 1和P = 0.68，分别）。
可弯曲胸腔镜检查或开胸手术实现的肺固定术显示出相似的结果。我们认为可弯曲胸腔镜检查可能是促进持续性漏气微创治疗的有效替代方法。需要进一步研究来证实这些结果。
