Kohiyama R, Yamashita R, Okano R, Kai T, Kuratomi Y, Miyata M
Department of Integrated Medicine, Jichi Omiya Medical Center, Japan.
Kyobu Geka. 1994 Mar;47(3):252-5.
A 59-year-old male was performed right pneumonectomy with R 2 b lymph node dissection and intercostal muscle flap to the bronchial stump for squamous cell carcinoma of right upper lobe of the lung (cT 2 N 2 M 0-stage III A). But four weeks later bronchial stump was suddenly reopened and he developed empyema. Omentopexy for bronchopleural fistula (15 x 11 mm in size) and thoracoplasty for empyema was performed. Bronchoscopically the fistula is 2 mm in diameter and reepithelization is started around the fistula at 14 POD and the fistula is completely closed and covered with reepithelized mucosa without inflammation at 100 POD. We think omentopexy for bronchopleural fistula after pneumonectomy is very effective procedure, so we should be considered this method at first. But if the fistula is accompanying empyema as our case thoracoplasty should be added.
一名59岁男性因右肺上叶鳞状细胞癌(cT2N2M0-ⅢA期)接受了右肺切除术、R2b淋巴结清扫术,并对支气管残端采用肋间肌瓣覆盖。但四周后支气管残端突然裂开,并发脓胸。针对大小为15×11毫米的支气管胸膜瘘进行了网膜固定术,并针对脓胸进行了胸廓成形术。支气管镜检查显示瘘管直径为2毫米,术后第14天瘘管周围开始重新上皮化,术后第100天瘘管完全闭合,被重新上皮化的黏膜覆盖且无炎症。我们认为肺切除术后针对支气管胸膜瘘的网膜固定术是非常有效的手术方法,因此应首先考虑该方法。但如果瘘管如我们的病例那样并发脓胸,则应加做胸廓成形术。