Vincent Yohann, Lenzini Alessandra, Hanna Amir, Leymarie Nicolas, Le Picault Brendan, Fadel Elie
Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, 2 Boulevard Sainte Anne, Toulon, France.
Department of Thoracic and Vascular Surgery, and Lung Transplantation, Marie-Lannelongue Hospital, Le Plessis-Robinson, France.
J Cardiothorac Surg. 2025 Jan 16;20(1):67. doi: 10.1186/s13019-024-03285-7.
Post-pneumonectomy bronchopleural fistula (BPF) is a life-threatening event whose treatment is not standardized.
We report the management of a 28-year-old patient with a 3-year history of BPF complicating right pneumonectomy for congenital emphysema. Despite closure by an Amplatzer device, the patient had chronic pyothorax and severely deteriorated general health and quality of life. An attempt at Amplatzer device removal through an open window thoracostomy failed. A median sternotomy was performed, the carina was resected, and the left main bronchus was anastomosed to the trachea. The thoracostomy was closed using fasciocutaneous pedicled flaps. At 9 months, the patient was doing well.
The utilisation of an Amplatzer device to close a broncho-pleural fistula can have adverse effects and potentially result in fatal sepsis in those cases where it is unsuccessful. The endoscopic treatment of BPF should be reserved for expert centers, considering the location, size, and stability of the fistula when choosing the treatment strategy. The surgical management of failed Amplatzer closure may be extremely complex, requiring a highly experienced team.
肺切除术后支气管胸膜瘘（BPF）是一种危及生命的情况，其治疗尚无标准化方案。
我们报告了一名28岁患者的治疗情况，该患者因先天性肺气肿行右肺切除术后发生BPF，病史3年。尽管使用Amplatzer装置进行了封堵，但患者仍有慢性脓胸，全身健康状况和生活质量严重恶化。通过开胸开窗术尝试取出Amplatzer装置失败。遂行正中胸骨切开术，切除隆突，并将左主支气管与气管吻合。采用带蒂筋膜皮瓣关闭胸廓造口。9个月时，患者情况良好。
在某些情况下，使用Amplatzer装置闭合支气管胸膜瘘可能产生不良影响，并可能导致致命性脓毒症，若封堵失败则后果严重。考虑到瘘口的位置、大小和稳定性，BPF的内镜治疗应仅在专业中心开展，并据此选择治疗策略。对于Amplatzer封堵失败的手术处理可能极其复杂，需要经验丰富的团队。
