【摘要】 目的:分析肺癌术后如何预防和治疗支气管胸膜瘘。方法:回顾性分析本科2001年1月～2008年2月以来收治的727例支气管肺癌行肺切除手术患者的临床资料。手术中均采用周围有生机组织包埋支气管残端,系统性纵隔淋巴结清扫同时细心保护支气管残端血运,支气管残端均送术中冰冻无一例切端癌细胞残留。并发支气管胸膜瘘的10例病人患者分别采用胸腔闭式引流、胸腔冲洗、经纤维支气管镜医用耳脑胶(EC胶)封堵、带膜支气管支架封堵瘘口、瘘口修补加肋间肌包埋以及胸廓成形术等方法治疗。结果:预防肺癌行肺切除术后支气管胸膜瘘727例中有10例并发支气管胸膜瘘,发生率1.4%;5例治愈,治愈率50.0%;3例因严重感染死亡,死亡率30.0%;2例瘘口未愈合长期引流,好转率70.0%。1例单纯胸腔闭式引流保守治疗治愈,3例经纤维支气管镜下瘘口医用耳脑胶(EC胶)封堵治愈,1例采用支气管残端修补、肋间肌瓣填塞并改良胸廓成形术治愈。10例均获随访,中位生存期为13个月。结论:提高支气管残端闭合技术、注重围手术期高危因素的防治是预防肺癌术后支气管胸膜瘘的关键。根据患者的具体情况包括一般情况、瘘口大小、感染严重程度等设计治疗方案是治疗肺癌术后支气管胸膜瘘的重点。更多还原

【Abstract】 Objective: Bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. BPF after lung resection is a fatal complication of surgery in the lung and represents a challenge of management problem and is associated with high morbidity and mortality. This study was to analyze the prevention and treatment of bronchopleural fistula after lobectomy for lung cancer. Methods: Ten cases of bronchopleural fistula were found through a review of 727 cases who received pulmonary resections in our hospital between 2001 and 2008. Particular care must be exercised to maintain blood flow through the bronchial stump, which was embedded with peripheric virgin tissues and free of malignant cells by histological test, during systematic mediastinal lymph node-scavenging. Patients with BPF after pneumonectomy were treated with closed drainage of thoracic cavity, thoracic cavity rinsing, endoscopic gluing of the fistula, the covered tracheal stents, closure of bronchopleural fistula with a pedicled intercostal muscle flap, and thoracoplasty , respectively. Results: The treatment of BPF included various surgical and medical procedures in this study. Patients with BPF after pneumonectomy were treated with closed drainage of thoracic cavity, anti-infection treatment and nutritional support. One patient was cured by closed drainage of thoracic cavity. Three patients were cured by endoscopic gluing of the fistula. One patient was cured by closure of bronchopleural fistula with a pedicled intercostal muscle flap and thoracoplasty. Of the 10 patients with bronchopleural fistula, 5 patients had a curative rate of 50.0 %, 3 patients died from severe infection with a mortality rate of 30.0 %, 2 patients continuously drainaged for the failure of orificium fistulae healing, with a total improvement rate of 70.0 %. All of the 10 cases were followed up, and the median life span was 13 months. Conclusion: For the prevention of bronchopleural fistula, the key factors included the technical improvement of bronchopleural fistula closure and the treatment of high risk factors during perioperative period. The emphasis is the formulation of individu- al therapeutic regimen according to the clinical setting including the size of orificium fistulae and the severity of infection.更多还原