Hollaus P H, Lax F, Janakiev D, Lucciarini P, Katz E, Kreuzer A, Pridun N S
Department of Thoracic Surgery, Pulmologisches Zentrum, Vienna, Austria.
Ann Thorac Surg. 1998 Sep;66(3):923-7. doi: 10.1016/s0003-4975(98)00589-x.
The value of bronchoscopic sealing of bronchopleural fistulas was studied retrospectively.
The cases of 45 patients seen between 1983 and 1996 with bronchopleural fistula after pneumonectomy (40 patients) or lobectomy (5 patients) were reviewed. Age, underlying disease, side, fistula size (millimeters) at initial bronchoscopy, survival (days) after endoscopic treatment, mode and number of endoscopic interventions, interval (days) between operation and fistula occurrence, and pathologic TNM stage in the case of malignancy were recorded. On the basis of the therapeutic outcome (cure, death, chronic empyema with closed fistula, or chronic empyema with open fistula) and the modality (successful sealing or bronchoscopic failure with subsequent surgical intervention), various groups were assessed and compared.
Of 29 patients (64%) treated only endoscopically, 9 were cured. Seven patients had fistula closure, but persistent chronic empyema necessitated permanent drainage. In another 7 patients, the fistula remained open and also was controlled by permanent drainage. Six patients in this group died. The overall rate of fistula closure was 35.6% (16 patients), and recurrence occurred in 2 patients. Sixteen patients (35.6%) required surgical intervention because of increasing fistula size (8 patients), sepsis with refractory empyema (7), and fecal empyema (1 patient). Two patients in the surgical group died. Small fistulas (<3 mm) responded particularly well to primary endoscopic treatment.
Bronchoscopic treatment of bronchopleural fistula appears an efficient alternative, especially when surgical intervention cannot be done because of the physical condition of the patient.
对支气管胸膜瘘的支气管镜封堵术价值进行回顾性研究。
回顾了1983年至1996年间45例肺叶切除术后（40例）或肺段切除术后（5例）发生支气管胸膜瘘患者的病例。记录患者年龄、基础疾病、瘘口所在侧、初次支气管镜检查时瘘口大小（毫米）、内镜治疗后的生存时间（天）、内镜干预方式及次数、手术与瘘口发生之间的间隔时间（天），以及恶性肿瘤患者的病理TNM分期。根据治疗结果（治愈、死亡、瘘口闭合的慢性脓胸或瘘口开放的慢性脓胸）和治疗方式（成功封堵或支气管镜治疗失败后行手术干预），对不同组进行评估和比较。
仅接受内镜治疗的29例患者（64%）中，9例治愈。7例瘘口闭合，但因持续存在慢性脓胸需长期引流。该组另外7例患者瘘口仍开放，也通过长期引流得到控制。该组6例患者死亡。瘘口闭合的总发生率为35.6%（16例患者），2例复发。16例患者（35.6%）因瘘口增大（8例）、脓毒症伴难治性脓胸（7例）和粪性脓胸（1例）需要手术干预。手术组2例患者死亡。小瘘口（<3毫米）对初次内镜治疗反应特别良好。
支气管胸膜瘘的支气管镜治疗似乎是一种有效的替代方法，尤其是在因患者身体状况无法进行手术干预时。
