右胸径路切割闭合器闭合左主支气管残端瘘并一期或分期治疗左脓胸  

The closure of the left-main-bronchial stump fistula using endoscopic liner cutter staplers through the right thoracic approach andⅠstage or staged treatment for the left pyothorax

作　　者：杨光煜 冼磊[1] 黄初生 刘涛[1] 赵文[1] 梁祥森[1] 孙宇[1] 杨胜壮 刘文洲[1] 毕笑寒 梁飞海 汪梦寰 陈有容 Yang Guangyu;Xian Lei;Huang Chusheng;Liu Tao;Zhao Wen;Liang Xiangsen;Sun Yu;Yang Shengzhuang;Liu Wenzhou;Bi Xiaohan;Liang Feihai;Wang Mengchen;Chen Yourong(Department of Cardiothoracic Surgery,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530000,China)

机构地区：[1]广西医科大学第二附属医院胸心血管外科,南宁530000

出　　处：《中华胸心血管外科杂志》2021年第3期145-148,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结右胸径路使用切割闭合器闭合左主支气管残端瘘并一期或分期治疗左脓胸的经验。方法6例左主支气管残端瘘合并脓胸患者,采用右胸径路关闭、切断左支气管残端,并用带蒂胸膜覆盖远、近端切缘加左胸T管引流一期或分期处理左脓胸。结果6例左主支气管残端均闭合良好,随访103~548天,均无再瘘;其中4例无脓胸复发,1例放置T管引流后仍反复出现脓胸,间隔行T管引流,1例行左胸开窗引流患者等待二期手术。结论右胸径路手术方法较胸骨正中径路手术创伤小,不易损伤左主支气管周围组织、脏器;腔内切割闭合器的使用,可降低左主支气管切缘出血、感染、再瘘的风险;T管引流一期或分期治疗左脓胸是一种化繁为简的方案。右胸径路切割闭合器闭合左主支气管残端瘘并一期或分期治疗左脓胸是一种简单、有效、安全、创伤小的手术方法。Objective To review the experience of closure of the left-main-bronchial stump fistula using endoscopic liner cutter staplers through the right thoracic approach and I stage or staged treatment for the left pyothorax.Methods 6 patients with the left-main-bronchial stump fistula after left pneumonectomy combined with pyothorax were treated by closing the left-main-bronchial stump using endoscopic liner cutter staplers through the right thoracic approach,and pleura was used to cover the distal and proximal incisional margin of the stump respectively.The thoracic T-tube drainage was used in the I stage or staged treatment for the left pyothorax.Results All patients were survived without recurrence of the bronchopleural fistula.4 patients were observed to have no recurrence of pyothorax when 1 patient had recurrence of pyothorax and was treated with intermittent T-tube drainage.1 patient operated with left-thoracic fenestration in the past was treated with drainage waiting for secondary operation.Conclusion The right thoracic approach seemed to be a safer and more effective method than the transsternal transpericardial approach in cases with the left-main-bronchial stump fistula combined with pyothorax.The use of endoscopic liner cutter staplers reduced the risk of bleeding,infection and recurrence of fistula.The T-tube drainage in the I stage or staged treatment for the left pyothorax was considered to be an easier way for treatment.

关 键 词：左主支气管残端瘘 右胸径手术 全肺切除术 并发症 切割闭合器 

分 类 号：R655[医药卫生—外科学]