Haraguchi S, Koizumi K, Gomibuchi M, Matsushima S, Masaki Y, Akiyama H, Mikami I, Fukushima M, Iida T, Tanaka S
Second Department of Surgery, Nippon Medical School, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Oct;44(10):1835-9.
Bronchopleural fistulas (BPF) developed in six (7.9%) of 76 patients who underwent a pneumonectomy for treatment of lung cancer. Five patients (18.2%) underwent a right pneumonectomy and one (3.7%) a left pneumonectomy. All patients were male, had squamous cell carcinoma, and were diagnosed as having BPF within one month after pneumonectomy. Their average age was 60.2 years. Univariate analyses related to development of BPF showed that significant risk factors were preoperative infection (Chi-square test; p < 0.001), right pneumonectomy (Chi-square test; p < 0.05), and metastasis to a subcarinal lymph node (Chi-square test; p < 0.05). However, sex, age, operating time, amount of blood loss during surgery, amount of blood transfused during surgery, history of smoking, degree of lymph node dissection, degree of curability, performance of combined resection, histologic type of tumor, tumor size, presence of residual tumor at the bronchial stump, and suturing method were not significant risk factors for development of BPF. Our stepwise regression analysis related to development of BPF showed that preoperative infection, metastasis to a subcarinal lymph node, right pneumonectomy, and combined resection were significant risk factors. Sometimes it is difficult to preserve the bronchial arteries upon the dissection of metastatic subcarinal lymph nodes which tightly adhere to the bronchial sheath. Moreover, after a conventional right pneumonectomy, the bronchial stump protrudes into the pleural cavity and is not covered by any tissue. Ligation of the bronchial arteries or protrusion of the bronchial stump into the right pleural cavity reduces the blood supply to the bronchial stump to a very low level and causes development of BPF. Therefore, we suggest that control of preoperative infection, wrapping of the bronchial stump, and preservation of the bronchial arteries during mediastinal lymph node dissection are important to prevent development of BPF.
在76例因肺癌接受肺切除术的患者中，有6例（7.9%）发生了支气管胸膜瘘（BPF）。5例患者（18.2%）接受了右肺切除术，1例（3.7%）接受了左肺切除术。所有患者均为男性，患有鳞状细胞癌，且在肺切除术后1个月内被诊断为BPF。他们的平均年龄为60.2岁。与BPF发生相关的单因素分析表明，显著的危险因素是术前感染（卡方检验；p<0.001）、右肺切除术（卡方检验；p<0.05）和隆突下淋巴结转移（卡方检验；p<0.05）。然而，性别、年龄、手术时间、手术中失血量、手术中输血量、吸烟史、淋巴结清扫程度、治愈程度、联合切除术的实施、肿瘤的组织学类型、肿瘤大小、支气管残端有无残留肿瘤以及缝合方法并非BPF发生的显著危险因素。我们与BPF发生相关的逐步回归分析表明，术前感染、隆突下淋巴结转移、右肺切除术和联合切除术是显著的危险因素。在解剖紧密附着于支气管鞘的转移性隆突下淋巴结时，有时难以保留支气管动脉。此外，传统的右肺切除术后，支气管残端突入胸腔且没有任何组织覆盖。支气管动脉结扎或支气管残端突入右胸腔会使支气管残端的血供降至极低水平并导致BPF的发生。因此，我们建议控制术前感染、包裹支气管残端以及在纵隔淋巴结清扫期间保留支气管动脉对于预防BPF的发生很重要。
