Morita R, Onizuka M, Mitsui K, Akaogi E, Ishikawa S, Suga M
Department of Surgery, University of Tsukuba, Ibaraki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jun;43(6):913-6.
A 61-year-old man received right middle and lower lobectomies for lung abscess caused by bronchiectasis in 1957. Since the right upper lobe was destroyed and multiple peripheral bronchopleural fistulae developed later, open thoracostomy was done in 1990. For this patient we performed transpericardial completion pneumonectomy with omental pedicle flap in 1993. He was complicated in a transient thoracic empyema. But he recovered by open drainage followed by surgical closure using Clagett's method and remains well 2 years after the radical operation. Transpericardial approach with omental pedicle flap though a median sternotomy seemed useful to prevent the postpneumonectomy bronchopleural fistula in this patient with thoracic empyema. But the primary closure of the empyema cavity should not be done, if dead space remains in the pleural cavity.
一名61岁男性于1957年因支气管扩张导致肺脓肿接受了右肺中下叶切除术。由于右上叶遭到破坏，后来出现了多处外周支气管胸膜瘘，1990年进行了开胸造口术。1993年，我们为该患者实施了带网膜蒂瓣的心包内全肺切除术。他出现了短暂的胸腔积脓并发症。但通过开放引流，随后采用克拉吉特法进行手术闭合，他康复了，根治性手术后2年情况良好。对于这名患有胸腔积脓的患者，经胸骨正中切口采用带网膜蒂瓣的心包内入路似乎有助于预防肺切除术后支气管胸膜瘘。但如果胸膜腔内仍存在死腔，则不应进行脓腔的一期闭合。
