Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, 215000, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
J Cardiothorac Surg. 2024 Nov 21;19(1):634. doi: 10.1186/s13019-024-03131-w.
To explore the value of our protocol of respiratory endoscopy intervention in the treatment of refractory persistent air leakage(PAL) after pulmonary surgery.
A retrospective study was conducted in 12 patients with PAL after pulmonary surgery who were successfully treated by our protocol of respiratory endoscopy intervention in the Department of Respiratory and Critical Care Medicine of the Fourth Hospital Affiliated to Soochow University and the First Hospital Affiliated to Soochow University from December 2019 to January 2024. 4 types of treatment were included in our protocol; A: chest tube drainage combined with negative pressure suction; B: medical thoracoscopy with chest tube as a path; C: stimulating bronchial mucosa hyperplasia under bronchoscopy; D: blocking of the fistula orifice with the relevant materials under the bronchoscope; And the specific treatment received by each patient was based on the condition of the patient.
The bronchopleural fistula was found in 7 patients; The fistula orifice was found in 5 patients and the diameter of fistula orifices were 4.0-12.0 mm, with an average of 7.2 ± 3.6 mm. Among the 7 patients with bronchopleural fistula, 1 patient received C + D, 1 patient received A + B + C, 1 patient received A + C + D, 4 patients received A + B + C + D; Among the 5 patients with fistula orifice, 2 patients received C + D, 2 patients received A + B + D, 1 patient received A + C + D. All the 12 patients were effectively treated, among which 9 patients who underwent chest tube drainage were successfully extubed. The median (interquartile distance) retention time of chest tubes before and after our protocol of respiratory endoscopy intervention were respectively 73.5(50.5,106.25) days and 29(22,38.75) days, p < 0.05.
Our protocol of respiratory endoscopy intervention can significantly shorten the retention time of the patient's chest tube and effectively treat refractory PAL after pulmonary surgery. However, it should be emphasized that individualized therapy should be provided according to the location and size of the fistula orifice.
探讨呼吸内镜介入治疗方案在肺手术后难治性持续性肺漏气（PAL）中的应用价值。
回顾性分析 2019 年 12 月至 2024 年 1 月在苏州大学附属第四医院和苏州大学附属第一医院呼吸与危重症医学科采用呼吸内镜介入治疗方案成功治疗的 12 例肺手术后 PAL 患者的临床资料。方案中包括 4 种治疗类型：A：胸腔引流管联合负压吸引；B：以胸腔引流管为路径的内科胸腔镜；C：支气管镜下刺激支气管黏膜增生；D：支气管镜下使用相关材料封堵瘘口。每位患者接受的具体治疗方法根据患者的病情而定。
7 例患者为支气管胸膜瘘，5 例患者发现瘘口，瘘口直径为 4.0-12.0mm，平均 7.2±3.6mm。7 例支气管胸膜瘘患者中，1 例接受 C+D，1 例接受 A+B+C，1 例接受 A+C+D，4 例接受 A+B+C+D；5 例瘘口患者中，2 例接受 C+D，2 例接受 A+B+D，1 例接受 A+C+D。12 例患者均得到有效治疗，其中 9 例经胸腔引流管引流的患者成功拔管。接受呼吸内镜介入治疗方案前后患者胸腔引流管留置时间的中位数（四分位距）分别为 73.5（50.5，106.25）天和 29（22，38.75）天，P<0.05。
呼吸内镜介入治疗方案可显著缩短患者胸腔引流管留置时间，有效治疗肺手术后难治性 PAL，但应强调应根据瘘口位置和大小制定个体化治疗方案。
