内镜下凡士林纱条封堵治疗支气管瘘的疗效和安全性分析  

Effect and safety of endobronchial placement of vaseline gauze in the treatment of patients with bronchial fistula

作　　者：吴晓东 唐荣娟 陈荣璋 高少勇 胥武剑 罗志兵 李强 Wu Xiaodong;Tang Rongjuan;Chen Rongzhang;Gao Shaoyong;Xu Wujian;Luo Zhibing;Li Qiang(Department of Respiratory and Critical Care Medicine,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院呼吸与危重症医学科,上海200120

出　　处：《中华医学杂志》2022年第44期3515-3519,共5页National Medical Journal of China

基　　金：浦东新区临床高峰学科(PWYgf2021-05);2019旭日人才计划(2019xrrcjh05)。

摘　　要：目的回顾性分析接受内镜下凡士林纱条封堵治疗的支气管瘘患者临床资料,评价该新封堵技术的临床疗效和安全性。方法收集2019年6月至2022年6月期间,同济大学附属东方医院呼吸与危重症医学科收治的接受呼吸内镜下凡士林纱条封堵治疗的14例支气管瘘患者临床资料,男女各7例,年龄16~74岁。回顾术后6~12个月的随访信息,记录术后胸腔引流管是否拔除、瘘口经封堵治疗后是否复发,不良事件(封堵纱条脱落、阻塞性感染、肺不张等)的发生情况。结果14例支气管瘘患者中,3例为主支气管或叶支气管残端瘘,10例为段支气管及亚段或次亚段支气管瘘,1例同时存在叶支气管残端瘘与亚段支气管瘘;合并胸腔或肺部感染10例;气胸或液气胸5例。14例患者均接受了内镜下凡士林纱条封堵治疗,均在术后取得封堵成功,11例术前有胸腔闭式引流管的支气管胸膜瘘患者在治疗后成功拔除胸腔引流管。3例患者在后续随访中取出封堵纱条,瘘口未再复发;余11例患者未取出封堵纱条,在随访中原瘘口未出现复发。未发生因严重并发症导致封堵治疗失败的情况。结论内镜下凡士林纱条腔内封堵治疗支气管瘘是一种安全、有效的新方法。Objective To investigate the application of vaseline gauze to occlude the bronchial fistulas and its clinical effectiveness and safety in this retrospective study.Methods This study retrospectively reviewed the clinical records of 14 patients with bronchial fistulas at Department of Respiratory and Critical Care Medicine,Shanghai Dongfang Hospital affiliated to Tongji University between June 2019 and June 2022.Seven of the 14 patients were female,and the age ranged from 16 to 74 years.We retrieved all the clinical records of all the enrolled patients during the 6 to 12 months follow-up after the operation,including the information for removal of chest drainage pipe,the failure of endobronchial blockage using vaseline gauze,as well as the complications(migration of the vaseline gauze,obstructive pneumonia,pulmonary atelectasis,et.al.)after the operation.Results Of the 14 patients,3 patients had fistula located in main or lobar bronchi;10 patients had fistula located in distal airways;and 1 patient had fistula located both in main bronchi and distal airways.Ten patients were complicated with pneumonia or pleural cavity infections;Five were complicated with pneumothorax or hydropneumothorax.All of the 14 patients achieved successful airway occlusion after the placement of vaseline gauze in the responsible bronchial airways or stumps for the fistulas.Eleven of the 14 patients successfully removed the drainage tube for the residual cavity,3 of the 14 patients successfully removed the vaseline gauze for the fistula which was healing during the follow up of 6-12 months.No one of the patients had severe complications or treatment failure.Conclusion Bronchial placement of vaseline gauze might be a feasible and effective technique for treatment of bronchial fistulas.

关 键 词：支气管瘘 气管 腔内封堵 凡士林纱条 随访 

分 类 号：R562.24[医药卫生—呼吸系统]