个体化精准治疗在闭合肺癌切除术后支气管胸膜瘘中的应用价值  

The application value of individualized precision treatment for closure of bronchopleural fistula after lung cancer resection surgery

作　　者：何忠良[1] 徐卫华[2] 辛顺心 陈国兴[1] 何雪明[1] 王磊 He Zhongliang;Xu Weihua;Xin Shunxin;Chen Guoxing;He Xueming;Wang Lei(Department of Cardiothoracic Surgery,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Department of Respiratory and Critical Care Medicine,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院心胸外科,杭州310012 [2]浙江省立同德医院呼吸与危重症医学科,杭州310012

出　　处：《中国防痨杂志》2025年第3期282-286,共5页Chinese Journal of Antituberculosis

基　　金：浙江省中医药科技研究计划项目(2025ZL222)。

摘　　要：目的:总结和评估个体化精准治疗在闭合肺癌切除术后支气管胸膜瘘(bronchopleural fistula,BPF)中的处理方法和临床价值。方法:选取2018年7月至2023年5月浙江省立同德医院收治的非小细胞肺癌术后BPF患者作为研究对象,共57例。研究对象均经充分前期准备和多学科讨论,根据BPF的部位和大小应用个体化精准治疗进行闭合处理,其中小瘘周围型应用外科精准注胶法将生物胶注射到瘘道内闭合,中瘘中间型应用外科套线法联合内镜单向活瓣等闭合,大瘘中央型应用外科改良手术修补联合内镜心脏封堵器等闭合。分析个体化精准治疗的临床疗效。结果:57例研究对象均完成个体化精准治疗,无住院死亡;术后4例(7.0%)无效,3例(5.3%)部分缓解;50例(87.7%)临床症状缓解;2例(3.5%)并发吸入性肺炎,2例(3.5%)并发皮下积血,3例(5.3%)并发切口感染,均经治疗好转。17例小瘘的患者经治疗闭合成功16例,1例无效。25例中瘘的患者经治疗闭合成功23例,无效1例,部分缓解1例。15例大瘘的患者经治疗闭合成功11例,无效2例,部分缓解2例。结论:肺癌切除术后BPF应用个体化精准治疗进行闭合,成功率高,疗效显著。Objective:To summarize and evaluate the treatment methods and clinical value of individualized precision therapy for closure of bronchopleural fistula(BPF)after lung cancer resection.Methods:A total of fifty-seven postoperative BPF patients with non-small cell lung cancer admitted to Tongde Hospital of Zhejiang Province from July 2018 to May 2023 were selected as the research subjects.The research subjects underwent thorough preparation and multidisciplinary discussions,and personalized precision treatment was applied for closure based on the location and size of the BPF.For small fistulas,precise surgical injection of biological glue was used to close the fistula tract.For middle fistulas,surgical suture combined with endoscopic one-way valves was used for closure.For large fistulas,improved surgical repair combined with endoscopic cardiac occluders was used for closure.The clinical efficacy of individualized precision therapy was analyzed.Results:All 57 study subjects completed individualized precision treatment without any in-hospital deaths.After surgery,4 cases(7.0%)were ineffective,and 3 cases(5.3%)showed partial remission;50 cases(87.7%)showed clinical symptom relief;two cases(3.5%)were complicated with aspiration pneumonia,two cases(3.5%)were complicated with subcutaneous hemorrhage,and three cases(5.3%)were complicated with incision infection,all of which improved after treatment.Among the 17 patients with small fistulas,16 were successfully closed after treatment,and 1 was ineffective.Among the 25 patients with middle fistulas,23 were successfully closed after treatment,1 was ineffective,and 1 partially relieved.Among the 15 patients with large fistulas,11 were successfully closed after treatment,2 were ineffective,and 2 partially relieved.Conclusion:The application of personalized precision treatment for closure of BPF after lung cancer resection has a high success rate and significant therapeutic effect.

关 键 词：支气管胸膜瘘 肺肿瘤 治疗应用 外科手术 

分 类 号：R56[医药卫生—呼吸系统]