Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany.
Department Paediatric Surgery and Paediatric Urology, Children's Hospital, University of Tuebingen, Tuebingen, Germany.
BMC Pediatr. 2022 May 5;22(1):250. doi: 10.1186/s12887-022-03298-y.
Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices.
A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful.
Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date.
支气管胸膜瘘（BPF）是肺炎或肺部手术后的一种严重并发症，可导致持续性空气泄漏（PAL）和气胸。手术选择包括切除、胸腔镜手术（VATS）覆盖瘘口或胸膜固定术。介入性支气管镜检查在复杂病例中更为首选，涉及使用硬化剂、密封剂和闭塞阀装置。
一名 2.5 岁女孩因持续发热、咳嗽和呼吸困难而入院。临床和影像学检查显示右侧肺炎和胸腔积液。患儿开始使用抗生素，胸腔积液通过胸腔引流排出。胸腔引流管取出后，患儿出现张力性气胸。尽管插入了新的引流管，但空气泄漏仍持续存在。4 周后，行胸腔镜清创术并放置另一个新的引流管，但仍未消除空气泄漏。支气管镜检查和支气管造影显示右肺段 3（右上叶前支气管）有 BPF。我们选择了介入治疗方法，在重复支气管镜检查时在全身麻醉下进行。在支气管造影显示瘘口后，将 2.7 French 微导管置于右肺段 3（上叶），通过连续植入 4 个可拆卸高密度填塞体积线圈来闭塞瘘口，将这些线圈放置到瘘口中。随后的支气管造影显示无残余漏出的证据，2 天后拔除胸腔引流管。胸部 X 线检查结果正常，随访 4 年以上无异常。
使用可拆卸高密度填塞大体积线圈对 BPF 进行支气管镜超选择性闭塞是一种成功的微创治疗干预措施，对患儿创伤最小，迄今为止尚未有报道。在我们的小患者中，介入时间短、局部干预和肺部损伤小，似乎优于在年轻生长的肺部进行的相应手术肺叶切除术或胸膜固定术，使周围组织正常发育。随访 4 年以上未出现任何副作用，至今肺功能检查结果正常。
