选择性支气管封堵术治疗胆管支气管瘘的疗效分析  

Efficacy of selective bronchial occlusion in the treatment of biliary bronchial fistula

作　　者：赵壁 黄锐晨 王琴 董宇超 白冲 黄海东 张伟 Zhao Bi;Huang Ruichen;Wang Qin;Dong Yuchao;Bai Chong;Huang Haidong;Zhang Wei(Department of Respiratory and Critical Care Medicine,the First affiliated hospital of Second Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院呼吸与危重症医学科,上海200433

出　　处：《中华医学杂志》2022年第44期3505-3509,共5页National Medical Journal of China

基　　金：海军军医大学“三航”人才培养计划“领航”项目。

摘　　要：目的分析选择性支气管封堵术(SBO)对胆管支气管瘘(BBF)的治疗效果。方法将2015年1月1日至2021年12月31日海军军医大学第一附属医院呼吸与危重症医学科收治的8例无胆道梗阻的胆管支气管瘘患者纳入研究,SBO治疗首次封堵分别以支气管硅胶塞(6例)和自体血+凝血酶(2例)作为封堵材料,行后续封堵治疗的7例患者中,5例采用支气管硅胶塞封堵,采用"支气管硅胶塞+子弹头覆膜支架"和"支气管硅胶塞+支气管单向活瓣"封堵各1例。收集患者SBO治疗相关临床资料并对其进行随访,分析SBO对胆管支气管瘘的治疗效果。结果研究对象BBF发病年龄为(58±9)岁,其中男性6例。首次SBO治疗采用支气管硅胶塞作为封堵材料的6例患者中,成功封堵1例,封堵后症状不缓解2例,术后即咳出封堵装置2例,出现新发瘘口1例;采用自体血+凝血酶作为封堵材料的2例患者封堵均失败。接受后续封堵治疗的7例患者中,采用"支气管硅胶塞+子弹头覆膜支架"(1例)和"支气管硅胶塞+支气管单向活瓣"(1例)封堵均获成功;采用支气管硅胶塞(5例)封堵2~6次后,封堵成功3例,咳胆汁样痰频率及痰量均减少50%及以上2例。术后并发症以发热和咳嗽(咳痰)等症状为主,分别为7和6例。随访期2例失访,其余6例随访时间为2~31个月,随访期内封堵治疗效果基本稳定,无死亡病例。结论SBO疗法提供了一种安全可行的BBF姑息治疗方式。Objective To analyze the effect of selective bronchial occlusion(SBO)in the treatment of biliary bronchial fistula(BBF).Methods Eight patients with BBF that without biliary obstruction admitted to the Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Naval Medical University from January 1,2015 to December 31,2021 were included in this study.Bronchial silicone plug(6 cases)and autologous blood+thrombin(2 cases)were used as sealing materials for SBO treatment for the first time.Among the 7 patients who underwent subsequent closure treatment,5 cases were blocked by bronchial silicone plug,1 case was blocked by"bronchial silicone plug+bullet-covered stent"and 1 case was blocked by"bronchial silicone plug+bronchial one-way valve".The clinical data related to SBO treatment were collected and patients were followed up,and the therapeutic effect of SBO on BBF was analyzed.Results The age of BBF onset was(58±9)years old,including 6 males.Among the 6 patients who used bronchial silicone plug as plugging material in the first SBO treatment,1 case was successfully plugged,2 cases did not achieve symptoms relief after plugging,2 cases coughed up the plugging device immediately after surgery,and 1 case developed a new fistula.Autologous blood and thrombin were used as sealing materials in 2 patients,and both failed.Among the 7 patients who received subsequent closure treatment,bronchial silicone plug+bullet-covered stent(1 case)and bronchial silicone plug+bronchial unidirectional valve(1 case)were successful.After 2-6 times of bronchial silicone plug(5 cases),fistula were successfully blocked in 3 cases,and the frequency and volume of bile-like sputum decreased by 50%or more in 2 cases.The main postoperative complications were fever and cough(expectoration)in 7 and 6 cases,respectively.During the follow-up period,2 patients were lost to follow-up,and the remaining 6 patients were followed up for 2-31 months.During the follow-up period,the effect of closure treatment was basically stable,an

关 键 词：胆瘘 支气管瘘 治疗结果 选择性支气管封堵术 随访 

分 类 号：R562.24[医药卫生—呼吸系统]