Kanda A, Takahashi S, Handa M, Sagawa M, Fujimura S
Department of Surgery, Sendai Kousei Hospital, Miyagi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Oct;45(10):1751-4.
A 62-year-old man underwent right lower lobectomy for adenocarcinoma (pT2N0M0) and nine days later, a bronchopleural fistula with empyema was evident. Six weeks following the lobectomy, excessive hemorrhage from the site of chest drainage and hemoptysis were noted. The bleeding and empyema were controlled by a two-stage approach. Anterior transpericardial approach was first made through the median sternotomy to clamp the right main pulmonary artery and then postero-lateral thoracotomy was conducted for the bronchopleural fistula with empyema. The right bronchial stump was covered with a pedicled muscle flap and pseudomonas aeruginosa, always positive in drainage effusion, consequently disappeared. The patient was discharged with a closed bronchus 4 months following the operation.
一名62岁男性因腺癌（pT2N0M0）接受了右下肺叶切除术，九天后，明显出现了伴有脓胸的支气管胸膜瘘。肺叶切除术后六周，发现胸腔引流部位大量出血和咯血。出血和脓胸通过两阶段方法得到控制。首先通过正中胸骨切开术采用经心包前入路夹闭右主肺动脉，然后对伴有脓胸的支气管胸膜瘘进行后外侧开胸手术。用带蒂肌瓣覆盖右支气管残端，引流液中一直呈阳性的铜绿假单胞菌因此消失。术后4个月，患者支气管闭合出院。
