全肺切除术后早期支气管胸膜瘘的治疗  

Management of early bronchopleural fistula after pneumonectomy

作　　者：李洋[1] 栾颖[1] 崔有斌[1] 李长远[1] 

机构地区：[1]吉林大学第一医院胸外科,长春130021

出　　处：《中华医学杂志》2016年第21期1692-1695,共4页National Medical Journal of China

摘　　要：目的 总结全肺切除术后早期支气管胸膜瘘的治疗.方法 回顾分析1983年2014年吉林大学第一医院32年间行全肺切除术,术后1个月内共发生30例支气管胸膜瘘患者的临床资料.这30例全肺切除术后早期支气管胸膜瘘的患者接受再次手术、闭式引流或开窗引流治疗、或内镜下生物胶封闭瘘口等治疗方法.结果 17例患者经再次手术关闭瘘口治疗,16例成功,1例死亡;12例支气管胸膜瘘接受引流治疗,其中单纯闭式引流6例,4例瘘口自行闭合,2例死亡;闭式引流结合开窗引流治疗6例,1例死亡;1例患者经纤维支气管镜黏膜下注射生物胶3次后成功堵塞瘘口.结论 发生于术后1个月内的瘘,如无明显脓性胸液,患者有足够的心肺储备可以耐受再次手术,应该急诊再次手术关闭瘘口,胸膜腔污染不是手术禁忌证,经原切口使用肋间肌瓣加强和修补瘘口是有效和便捷的.闭式引流和后期转为开窗引流治疗适用于心肺功能储备不能耐受再次手术、一般状态较差、已经形成明显脓性胸液或一些瘘口较小的患者.Objective To investigate the management of early bronchopleural fistula （BPF） within one month after pneumonectomy.Methods A total of 30 cases developed BPF within one month after pneumonectomy in recent 30 years were reviewed from First Hospital of Jilin University.All patients were treated by reoperation,closed drainage with or without open thoracic window,or endobronchial glue.Results Seventeen patients were returned to the operating room for reclosure of BPF,one patients died of BPF and 16 reoperations were successful.Twelve cases were treated by closed drainage with or without followed open thoracic window.In 6 patients who were managed by closed drainage alone,2 cases died of BPF and 4 bronchopleural fistulas closed spontaneously.In 6 patients treated with closed drainage and later with open thoracic window,one case died of BPF.One patient successfully underwent endoscopic glue to close BPF with injection three times.Conclusion Within one month postoperatively,BPF without established empyema with pus should be reoperated if the patient had enough cardiopulmonary reserve and could there fore tolerate reoperation.Contamination of pleural space is not the contraindication to reoperation.Reclosure via original thoracotomy and repair the fistula with pedicled intercostal muscle flap are convenient and efficient.Drainage with or without followed open thoracic window is appropriate for the patients with limited cardiopulmonary reserve,impaired general condition,secondary to empyema with pus,early recurred cancer,or some small fistulas.

关 键 词：胸膜 肺切除术 支气管瘘 

分 类 号：R655[医药卫生—外科学]