经支气管镜置入房间隔缺损封堵器治疗中心型气道胸膜瘘的临床疗效评价  

Clinical evaluation of endoscopic bronchial closure of central airway-pleural fistulas with the atrial septal defect occluders:long-term follow-up

作　　者：谭建龙[1] 陈风雨 欧阳彬[1] 张卫东[1] 邓红英[1] 李茸[1] 彭冉 刘志光[1] TAN Jianlong;CHEN Fengyu;OUYANG Bin;ZHANG Weidong;DENG Hongying;LI Rong;PENG Ran;LIU Zhiguang(Department of Respiratory Medicine,Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University,Changsha,Hunan 410005,P.R.China)

机构地区：[1]湖南省人民医院/湖南师范大学附属第一医院呼吸内科,湖南长沙410005

出　　处：《中国呼吸与危重监护杂志》2023年第6期403-407,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：湖南省卫生健康委员会科研计划(202203023386);湖南省人民医院仁术基金(RS201911);湖南省重点临床专科建设及技术创新项目[20191127-1006]。

摘　　要：目的探讨经支气管镜置入房间隔缺损封堵器治疗中心型气道胸膜瘘的安全性和有效性。方法共纳入于2017年1月—2021年10月期间我科收治的16例术后气道胸膜瘘患者,在局部麻醉联合复合静脉镇静镇痛下,经支气管镜置入房间隔缺损封堵器治疗,观察封堵治疗后的近期及远期疗效。结果16例患者年龄31~74岁,平均年龄60.7岁。气道胸膜瘘的形成均与手术相关,其中肺叶/段切除术12例,2例全肺切除术,1例食管癌根治术,1例因慢性脓胸行胸膜纤维层剥脱术。其中,右主残端瘘4例,左主残端瘘3例,右上叶支气管瘘3例,右中叶支气管瘘1例,右下叶支气管瘘2例,左上叶支气管瘘3例。瘘口直径7.8(4~18 mm),置入房间隔缺损封堵器腰径10.0(6~20)mm。15例患者成功封堵,1例患者在置入封堵器后14 d因菌血症所致多脏器功能衰竭死亡。14例纳入远期随访,随访时间3~46个月,中位值16.2个月,临床完全缓解12例,部分缓解2例,1例患者因瘘口扩大而出现封堵器移位。4例患者死亡,死亡原因与房间隔缺损封堵器置入操作无关。结论经支气管镜置入房间隔缺损封堵器能快速、有效封堵中心型气道胸膜瘘,且远期疗效较为肯定。Objective To explore the safety and efficacy for patients with central airway-pleural fistula(APF)treated by atrial septal defect(ASD)occluder.Methods This was a retrospective study.Between January 2017 and October 2021,a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation.The efficacy and complication were recorded during and after the procedure.Results Sixteen patients were recruited in this study and the average age was 60.7 years(range 31-74 years).The main etiology for APF was lobectomy/segmentectomy(n=12),pneumonectomy(n=2),radical esophagectomy(n=1)or decortication for chronic empyema(n=1).Totally,4 fistulas were located in right main bronchus,3 in left main bronchus,3 in right upper bronchus,1 in right middle bronchus,2 in right lower bronchus and 3 in left upper bronchus.The median diameter of APF was 7.8 mm(ranged from 4 to 18 mm)and the median diameter of ASD occluder inserted was 10.0 mm(ranged from 6 to 20 mm).Successful occlusion of APF was observed in 15 patients(15/16)and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure.Fourteen patients were recruited for long-term follow-up,on a median follow-up period of 16.2 months(ranged from 3 to 46 months).There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder.At follow-up,4 patients died and the reasons were directly related to the primary etiology,and no patient died due to APF recurrence.Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.

关 键 词：支气管胸膜瘘 支气管镜 房间隔缺损封堵器 

分 类 号：R561[医药卫生—呼吸系统]