肺部手术后支气管胸膜瘘的临床分析

摘要

Objective:To explore the risk factors,preventive measures and therapeutic methods for bronchopleural fistula (BPF) after lung resections.Methods:A restrospective analysis for 11 patients with BPF after pneumonectomy from April 2012 to June 2016 in Department of Thoracic Surgery,Xiangya Hospital,Central South University was performed.Their clinical characteristics,treatment and prognosis were analyzed,and the risk factors and effective therapeutic strategies were summarized.Results:Among the 11 patients with BPF,10 cases were cured finally,and 1 case with conservative treatment was dead.The total mortality rate was 9.09％.The 10 patients treated with positive measures were all cured,including 5 cases with pulmonary lobectomy and pneumonectomy,4 cases with amplatzer and covered stent,and 1 case with fibrin glue.One case with conservative treatment was dead because of respiratory failure.Conclusion:It is important to intervene BPF as early as possible.Fibrin glue via bronchoscope for tiny BPF after lung resection is preferred to be considered.We recommend to take early positive operation (pulmonary lobectomy and pneumonectomy) after pulmonary resection if the BPF cannot be cured via bronchoscope whereas the patients' condition is allowed.The amplatzer or covered stent should be considered first for the patient with BPF after pneumonectomy.%目的:探讨肺部手术后支气管胸膜瘘(bronchopleural fistula,BPF)的危险因素、预防措施及治疗方法.方法:回顾性分析中南大学湘雅医院胸外科2012年4月至2016年6月肺切除术后发生的11例BPF患者的临床资料,分析其临床特点、处理措施及预后,并总结其危险因素及有效的治疗方法.结果:11例BPF患者中,10例痊愈出院,1例死亡,病死率为9.09％.采用积极治疗的10例患者均痊愈出院,其中包括5例行急诊余肺或全肺切除的患者,4例行封堵器或支架治疗的患者,以及1例行生物胶治疗的患者;1例保守治疗的患者最终因呼吸衰竭而死亡.结论:BPF早期的积极干预至关重要.肺切除术后发生的微小瘘可首选纤维支气管镜下生物胶封堵;肺叶切除的患者发生BPF时,若患者条件允许且在纤维支气管镜下无法治愈,应尽早行余肺或全肺切除;全肺切除的患者发生BPF时,可优先考虑纤维支气管镜下放置封堵器或覆膜支架.