al-Kattan K, Cattalani L, Goldstraw P
Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
Ann Thorac Surg. 1994 Nov;58(5):1433-6. doi: 10.1016/0003-4975(94)91929-1.
We have reviewed the incidence of bronchopleural fistula among 530 consecutive pneumonectomies, all carried out by one surgical team using a uniform suture technique between January 1980 and November 1993. There were 7 fistulas (1.3%); all of them occurred within 15 days postoperatively. There were no cases of late fistula during a mean follow-up period of 23 months. The pathology for which pneumonectomy was undertaken was primary lung malignancies in 488 cases (92.1%), metastatic disease in 15 cases (2.8%), and benign diseases in 27 cases (5.1%). All fistulas developed after pneumonectomy for lung cancer. Other risk factors included age, preoperative radiotherapy, and the surgeon's level of experience, as only two fistulas occurred with the consultant who performed 410 pneumonectomies (0.5%). The bronchial stump was free of tumor in all cases. There were no fistulas in the 37 completion pneumonectomies (7%). All fistulas were treated within 2 days of diagnosis by resuturing the stump through the initial thoracotomy incision. That was successful in 5 patients, whereas fatal complications developed in the other 2 patients. We believe that suture closure of the bronchial stump at pneumonectomy provides a cheap and reliable technique that gives good results in all situations.
我们回顾了1980年1月至1993年11月期间由同一手术团队采用统一缝合技术连续进行的530例肺切除术患者支气管胸膜瘘的发生率。共有7例瘘管形成（1.3%）；所有瘘管均发生在术后15天内。在平均23个月的随访期内，无迟发性瘘管病例。行肺切除术的病理类型为原发性肺癌488例（92.1%）、转移性疾病15例（2.8%）、良性疾病27例（5.1%）。所有瘘管均在肺癌肺切除术后发生。其他风险因素包括年龄、术前放疗和外科医生的经验水平，因为在施行410例肺切除术的顾问医生的病例中仅发生了2例瘘管（0.5%）。所有病例的支气管残端均无肿瘤。37例全肺切除术（7%）中无瘘管形成。所有瘘管均在诊断后2天内通过原开胸切口重新缝合残端进行治疗。5例患者治疗成功，但另外2例患者出现致命并发症。我们认为，肺切除术中支气管残端的缝合闭合提供了一种廉价且可靠的技术，在所有情况下均能取得良好效果。
