纤维支气管镜下“三明治”疗法治疗肺手术后支气管胸膜瘘(BPF)

 目的  探索纤维支气管镜下“三明治”法治疗肺手术后支气管胸膜瘘(bronchopleural fistula,BPF)的可行性。方法  根据BPF的分类标准,选取肺切除术后中晚期瘘的患者,瘘口<5 mm且胸腔感染较轻者接受“三明治”法治疗。“三明治”法操作的具体步骤为:(1)在气管镜直视引导下将注射器针头插入瘘口周围黏膜下,注射1%乙氧硬化醇;(2)利用内镜注射器在瘘口表面滴注1%硝酸银,烧灼黏膜使其变灰白;(3)经内镜注射器于瘘口表面滴注1%硝酸银和20%白蛋白等比例混合的混悬液,封闭瘘口。结果  2010年10月至2014年11月,复旦大学附属中山医院胸外科共有11例肺切除术后BPF患者接受“三明治”法治疗,治愈9例,平均治疗次数1.8次,2例患者治疗失败,带管出院。经过随访,治愈的患者瘘口无复发,也没有出现远期不良反应。结论  纤维支气管镜下“三明治”法是一种安全有效的治疗方法,相比单纯的纤维支气管镜下硬化剂注射,注射次数少,成功率高。

Bronchoscopic "sandwich" therapy for bronchopleural fistula (BPF) following lung surgery

Objective  To explore the feasibility of bronchoscopic “sandwich” therapy for bronchopleural fistula (BPF) following lung surgery. Methods  According to the classification of BPF, patients with intermediate and terminal fistula after the pneumonectomy were enrolled in this study. In addition, for these patients, the size of fistula was less than 5 mm and the contamination of thoracic cavity was mild. The “sandwich” therapy consisted of 3 steps: (1) under direct vision we advance an endoscopic needle through the bronchoscope’s operating channel and then administer several submucosal injections of 1% polidocanol around the fistula;(2) 1% silver nitrate dripped on the surface of the fistula using ecndoscopic needle; (3) the suspension of 1% silver nitrate and 20% human albumin with equal proportion dripped on the surface of the fistula using ecndoscopic needle. Results  From Oct. 2010 to Nov. 2014, 11 patients were accepted with the “sandwicn” therapy, and 9 cases were cured and the mean treatment sections were 1.8 time. The therapy was failed in 2 patients, which were discharged with tube drainage. In the follow-up, there was no complication and no recurrence of BPF in these patients. Conclusions  Bronchoscopic “sandwich” therapy is a safe and effective treatment for BPF. Compared with the submucosal injections polidocanol alone, the advantages of the “sandwich therapy” were less treatment sections and higher cure rate.