Watanabe Takuya, Sakane Tadashi, Fujino Kosuke, Handa Yoshinori, Iida Takahiro, Shinohara Shuichi, Hanawa Ryutaro, Doi Takefumi, Ito Atsushi, Tanahashi Masayuki
Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Department of Thoracic Surgery, Nagoya City University West Medical Center, Nagoya, Japan.
Eur J Cardiothorac Surg. 2025 Jun 3;67(6). doi: 10.1093/ejcts/ezaf207.
Bronchopleural fistula (BPF) is a postoperative complication with a poor prognosis, and its treatment remains challenging. This study aimed to accumulate cases through a multi-institutional registry and gain insights to improve the treatment outcomes.
This retrospective multi-institutional study included patients who developed BPF after undergoing thoracic surgery between January 2000 and July 2023. The primary end-point was the BPF cure rate. Secondary end-points included overall survival and factors associated with non-cure.
This study included 81 patients. Endoscopic interventions were performed in 29.6% of patients, and BPF cure with endoscopic treatment alone was achieved in 20.8% of them. Surgery for BPF was performed in 85.2% of the patients, with open-window thoracostomy being the most frequent procedure. Among open-window thoracotomies, the cure rates with muscle flaps and omentum for closing windows were 82.4% and 100%, respectively. Overall, BPF was cured in 53.1% of the patients, while 46.9% were not cured. The mortality rate during the observation period was 58.0%, with BPF-related deaths accounting for 48.9%. A multivariate analysis identified low albumin levels (<3.0 g/l) and low haemoglobin levels (<11.0 g/l) at BPF onset as significant non-cure factors (odds ratio: 4.12, 95% CI 1.43-11.80; odds ratio: 3.53, 95% CI 1.28-9.75, respectively).
BPF remains a postoperative complication with both high non-cure and mortality rates. The nutritional status, particularly the albumin and haemoglobin levels at onset, significantly influences the outcomes, thus highlighting the importance of enhanced perioperative nutritional management to improve the BPF outcomes.
支气管胸膜瘘（BPF）是一种预后较差的术后并发症，其治疗仍然具有挑战性。本研究旨在通过多机构登记积累病例，并深入了解以改善治疗结果。
这项回顾性多机构研究纳入了2000年1月至2023年7月期间接受胸外科手术后发生BPF的患者。主要终点是BPF治愈率。次要终点包括总生存率和与未治愈相关的因素。
本研究纳入了81例患者。29.6%的患者接受了内镜干预，其中20.8%的患者仅通过内镜治疗实现了BPF治愈。85.2%的患者接受了BPF手术，开窗胸廓造口术是最常见的手术方式。在开窗胸廓造口术中，使用肌瓣和网膜关闭窗口的治愈率分别为82.4%和100%。总体而言，53.1%的患者BPF得到治愈，而46.9%的患者未治愈。观察期内的死亡率为58.0%，与BPF相关的死亡占48.9%。多变量分析确定BPF发病时低白蛋白水平（<3.0 g/l）和低血红蛋白水平（<11.0 g/l）是显著的未治愈因素（优势比分别为：4.12，95%可信区间1.43 - 11.80；优势比：3.53，95%可信区间1.28 - 9.75）。
BPF仍然是一种术后并发症，未治愈率和死亡率都很高。营养状况，特别是发病时的白蛋白和血红蛋白水平，对结果有显著影响，因此突出了加强围手术期营养管理以改善BPF治疗结果的重要性。
