Kalweit G, Feindt P, Huwer H, Volkmer I, Gams E
Department of Cardiothoracic Surgery, University Hospital, Homburg/Saar, Germany.
Eur J Cardiothorac Surg. 1994;8(7):358-62. doi: 10.1016/1010-7940(94)90029-9.
Between 1975 and June 1992, pneumonectomy was performed in 594 patients, of whom 33 (5.6%) developed bronchopleural fistulae postoperatively. Until 1989 25 cases were reoperated: 5 patients were treated by thoracoplasty primarily, 20 by repair of the stump with sutures and by covering the stump with pericardial tissue or intercostal muscle, of whom 10 suffered from empyema. In 5/20 patients (25%) chronic fistulae developed making further interventions necessary. Since 1989 seven patients with bronchial stump fistulae have been reoperated with a delay of less than 12 h after diagnosis. Surgery consisted of reclosure of the stump with sutures in five patients. In addition, every patient was treated with the intrathoracic transposition of a petiolated ipsilateral pectoral muscle graft, which was the only treatment in two patients. Neither recurrence of the bronchopleural fistula nor empyema was seen in this group of patients (0%). We conclude that bronchial stump fistulae in patients after pneumonectomy can be treated successfully by the use of pectoral muscle flaps either combined with a closure of the leak using sutures or as the only measure. The method proved to be simple, safe and without major impairment of the patient. In combination with early reintervention, postpneumonectomy empyema including a disfiguring thoracoplasty can thereby often be avoided.
1975年至1992年6月期间，594例患者接受了肺切除术，其中33例（5.6%）术后发生支气管胸膜瘘。截至1989年，25例患者接受了再次手术：5例患者首先接受胸廓成形术治疗，20例患者通过缝合修复残端并用心包组织或肋间肌覆盖残端，其中10例发生脓胸。在20例患者中的5例（25%）出现慢性瘘管，需要进一步干预。自1989年以来，7例支气管残端瘘患者在诊断后不到12小时接受了再次手术。手术包括5例患者用缝线重新闭合残端。此外，每位患者均接受了带蒂同侧胸肌移植的胸腔内移位治疗，2例患者仅接受了此治疗。该组患者均未出现支气管胸膜瘘复发或脓胸（0%）。我们得出结论，肺切除术后患者的支气管残端瘘可通过使用胸肌皮瓣成功治疗，可与使用缝线闭合漏口联合使用，也可作为唯一措施。该方法被证明简单、安全，且对患者无重大损害。结合早期再次干预，从而常常可以避免肺切除术后脓胸，包括造成毁容的胸廓成形术。
