Management of bronchopleural fistula with endobronchial valve in hybrid operating room following transbronchial microwave ablation

Transbronchial microwave ablation for the treatment of lung nodules is gaining popularity. In the present case, transbronchial microwave ablation to a right middle lobe lesion was performed under electromagnetic navigation bronchoscopy guidance. It was complicated with pneumothorax and persistent air leak despite chest drainage and chemical pleurodesis. A diagnosis of bronchopleural fistula was reached and an endobronchial valve was implanted to the middle lobe segmental bronchus with almost immediate cessation of air leak. Our case demonstrated that endobronchial valve is safe and effective in managing bronchopleural fistula after transbronchial microwave ablation.     

结核性脓胸伴支气管胸膜瘘的外科治疗

目的：总结１９６５￣１９８６年间,１２６例结核性脓胸支气管胸膜瘘病人的外科治疗经验。方法：全组病人分别接受闭式引流、Ｈｅｌｌｅｒ胸改加瘘修补术、胸膜外全肺切除或余切除术、带蒂网膜移植术等方法治疗。结果：１１２例获得临床治占８８．９％;好转８例;死亡例。结论：外科手术是结核性脓胸支气管胸膜瘘唯一有效的治疗方式。闭式引流、Ｈｅｌｌｅｒ胸改术仍具有不可替代的作用。     

Tracheoesophageal fistula in a child after blunt chest trauma

Traumatic tracheoesophageal fistula is a rare complication after blunt chest trauma, with all reported cases being more than 12 years of age. We report a 5-year-old boy with traumatic tracheoesophageal fistula after a blunt injury to the chest.     

Anesthetic management of a patient with aortocaval fistula

Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm (AAA), and patients with an aortocaval fistula show multiple symptoms. We report an 87-year-old man who was diagnosed as having an AAA with aortocaval fistula and who developed refractory hypotension after induction of anesthesia. Following a phenylephrine injection for slight hypotension induced by anesthetic induction, he developed severe hypotension and bradycardia, and his skin became cyanotic. Vasopressor agents had no immediate effect on the hypotension, but blood pressure gradually increased in about 30 min with continuous infusion of dopamine and noradrenaline. Transesophageal echocardiography (TEE) showed right ventricle (RV) hypokinesis and massive tricuspid regurgitation (TR). Central venous pressure (CVP) showed a remarkably high value. After the repair of the aortocaval fistula, the hemodynamics became stable, RV motion was improved, TR was reduced, and CVP became normal. Anesthetic management of the repair of an aortocaval fistula is very difficult. The hemodynamics changed dramatically throughout anesthesia in our patient with this disorder, even though low-dose anesthetics were used. For the successful treatment of this disorder, preparation for the operation is required before the induction of anesthesia, and urgent closure of the fistula is necessary after the induction of anesthesia. TEE is a useful tool for monitoring hemodynamics in such patients.     

Platypnea orthodeoxia syndrome and bronchopleural fistula following right pneumonectomy: The first case of double misfortune following pneumonectomy

We report a case of post-pneumonectomy right to left shunting via patent foramen ovale (PFO) and bronchopleural fistula (BPF). Although the latter complication is well-known following pneumonectomy, the former is quite rare. In terms of post-pneumonectomy complications, no case has been reported, in which right to left shunting via PFO and BPF were synchronous. Low awareness of post-pneumonectomy PFO often results in delay of the appropriate management, like in our experience. The rarity and the complexity of our case as well as literature review of the post-pneumonectomy right to left shunting via PFO are summarized.With our case of post-pneumonectomy right to left shunting via PFO and BPF reviewed, we would like to show the rarity of our case and to enlighten all of the thoracic surgeons for early detection of this hemodynamic complication following pneumonectomy.     

Anesthetic management for a patient with renal arterio-venous fistula

Key words  anesthesia - renal arterio-venous fistula - vascular resistance     

胸腔镜下脊柱侧凸矫形术的麻醉处理

目的回顾分析胸腔镜下脊柱侧凸矫形术麻醉管理应注意的问题。方法11例脊柱侧凸患者,ASAⅠ～Ⅱ级,静吸复合麻醉下行胸腔镜脊柱侧凸矫形术。所有患者均选择双腔管插管(Robertshaw)单肺通气。术中监测NIBP、HR、ECG、SpO2、PETCO2、吸入和呼出麻醉气体浓度(O2、N2O、异氟醚)、气道压(Paw)和脊髓功能。结果11例患者均成功完成手术。手术时间平均363(240～510)min,单肺通气时间平均310(180～420)min。术中BP、HR平稳。所有患者在改变体位及较长时间单肺通气后均有不同程度的SpO2降低以及Paw和PETCO2的升高,需重新调整双腔管的位置或短暂双肺通气才能缓解,其中4例患者术中需停吸N2O方能维持SpO2。结论充分的术前准备、双腔导管的准确定位、单肺通气技术、加强术中监测、麻醉医师和手术医师团结协作是确保胸腔镜下脊柱侧凸矫形手术取得成功的关键。     

Tracheo oesophageal fistula following blunt chest trauma

Tracheo-oesophageal fistula following blunt chest injury is very rare. Rarer still is the location of such a fistula in the cervical region. A case of cervical tracheo-oesophageal fistula in a boy following fall from a tree is reported. Sinus bradycardia, refractive to drugs was relieved by repair of the fistula. Management has been described in detail and relevant literature reviewed.     

再次开胸瘘修补术治疗肺切除术后早期支气管胸膜瘘

目的 总结采用再次手术瘘修补结合自体带蒂肌瓣组织包盖残端的方法治疗23例肺切除术后早期支气管胸膜瘘(BPF)(9例伴有胸腔感染)的经验,并对治疗选择进行探讨.方法 23例中第一次手术方式全肺切除13例,肺叶切除10例.BPF发生时间为术后5～40天,平均21天.BPF确诊后,立即行胸腔闭式引流术并考虑行二次开胸瘘修补术.4例采用直接缝合修补瘘口,10例重新切除残端至正常组织后再次缝合,7例切除残端后行支气管成形或隆凸成形术,2例将带蒂肌瓣缝合到瘘口边缘达到封闭;瘘修补后残端后包埋的肌瓣包括肋间肌瓣5例,肋背阔肌瓣10例、前锯肌瓣6例、骶棘肌2例.瘘修补术后常规给予胸腔冲冼.结果无术中及术后近期死亡.术后并发严重并发症4例,均对症治疗后痊愈.21例瘘口修补成功,失败2例,成功率为91.3％.1例修补后2年因残端复发致BPF伴脓胸,其余均无BPF复发.结论 肺切除术后早期BPF,即使有胸腔感染,如果预期可耐受手术,应尽早积极手术修补瘘口并以带蒂胸壁肌瓣包盖,结合术后胸腔持续冲洗,可获得良好效果.     

支气管胸膜瘘合并难治性脓胸个体化综合治疗分析

目的总结和分析支气管胸膜瘘合并难治性脓胸个体化综合治疗的方法和疗效。 方法2015年7月—2019年11月共收治支气管胸膜瘘合并难治性脓胸患者12例,其中男性10例,女性2例;年龄23～78岁,平均(60.75±15.05)岁。初始手术为非小细胞肺癌4例,肺部良性疾病4例,包裹性胸腔积液3例,恶性胸腺瘤肺转移1例。胸膜瘘发生后,采取经脓胸引流控制感染和介入封堵瘘口治疗;病情基本稳定后,行肌瓣移植术填塞脓腔等综合措施,并根据病情进行个体化治疗。 结果全组无围手术期死亡病例;在平均17.45个月的随访中,1例患者因肿瘤转移死亡;1例复发小脓腔;其余10例无支气管胸膜瘘和脓胸复发,肌瓣存活,复查胸部CT/MRI显示脓腔被彻底填塞。 结论对支气管胸膜瘘合并难治性脓胸患者采取个体化综合治疗措施,能达到彻底根治的目的,成功率高,疗效显著,值得推广。     

Anesthetic management of acquired tracheoesophageal fistula: a brief report

IMPLICATIONS: Tracheoesophageal fistula may be either a congenital lesion or an acquired condition, most often resulting from foreign body ingestion. Location of the lesion has implications for anesthetic management and single lung ventilation may be required to facilitate surgical repair. In pediatric patients, intentional mainstem intubation may be required.     

Subarachnoid-pleural fistula due to blunt chest trauma. A case report

Subarachnoid pleural fistula (SPF) due to blunt chest trauma is rare. When SPF isn't associated with any neurological deficits, its clinical diagnosis is possible only with high degree of suspicion. Presentation symptoms include dyspnea and respiratory distress caused by the collection of cerebral-spinal fluid in the pleural cavity. Computed tomography scan after myelography is helpful in confirming the site of the fistula. Possible dangerous complications are infections or pneumoencephalus. Some cases resolved spontaneously after bed rest or pleural drainage alone, while others required surgical repair. We report a case of spontaneous closure after pleural drainage and a brief period of mechanical ventilation.     

Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula

The anaesthetic management of a left pneumonectomy in a 18-month-old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. Pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.     

Effective treatment of empyema with bronchopleural fistula after esophagectomy by endobronchial embolization using endobronchial Watanabe Spigots

IntroductionEmpyema and bronchopleural fistula are well known complications after thoracic surgery. We report a case of refractory air leakage of bronchopleural fistula in a patient with empyema that was successfully treated by endobronchial embolization using Endobronchial Watanabe Spigots (EWSs).Presentation of caseA 71-year-old man underwent esophagectomy for primary esophageal cancer. A right empyema with bronchopleural fistula (BPF) developed four months after surgery. Right thoracic drainage tube was inserted. Although the empyema was treated by drainage and anti-biotics therapy, the air leakage was apparent. The chest computed tomography (CT) scan revealed that the bronchopleural fistula existed in the segment 6 and 10. Endobronchial embolization was performed to the responsible bronchus using EWSs. After the EWSs of middle and large sizes were inserted into the B⁶c and B¹⁰b + c, the air leakage was stopped. The thoracic tube of drainage was removed after endobronchial embolization. Complications due to the EWSs insertion were not observed, and the patient was discharged.DiscussionThe management of BPF has evolved over the years. Surgical approach is frequently needed to control the BPF, though endobronchial embolization is effective in closing the BPF in some patients. In our case, EWSs of middle and large size were useful to control air leakage. We safely retried the 2nd endoboronchial embolization using the EWS. The patient had no complication after insertion the EWS again.ConclusionEndobronchial embolization using EWSs was an effective treatment of an empyema with bronchopleural fistula after esophagectomy.     

One-stage pedicled omentum majus transplantation into thoracic cavity for treatment of chronic persistent empyema with or without bronchopleural fistula

Objective: Assessment of the present results of surgical treatment for chronic persistent empyema with or without bronchopleural fistula (BPF) using one-stage pedicled omentum majus transplantation into the thoracic cavity. Methods: From November 1979 to December 1996, 50 patients with chronic persistent empyema were treated by pedicled omentum majus transplanted into the thoracic cavity. There were 35 men and 15 women, and the age range was 15–58 years. Empyema had been present for 0.5–18 years. Twenty-six of 35 cases with chronic tuberculous empyema and six of 15 cases with chronic bacterial empyema suffered from concomitant BPF (n=32). In the latter, the most common organisms were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Results: There were no perioperative deaths. Two cases had a significant air leak on the first postoperative day. One of them underwent rethoractomy 30 h after the initial operation to stop the fistula using intrathoracic omentum. Thoracic dead space disappeared in most of the operated cases and a sterilized dry cavity remained in some cases. Conclusions: One-stage pedicled omentum majus transposition is a safe and easy procedure for chronic persistent empyema and BPF, it breaks down residual or recurrent inflammatory foci mechanically and closes the BPF effectively with minimal deformity of the chest wall.     

Anaesthetic management of tracheobronchial rupture following blunt chest trauma

Injuries to the tracheobronchial tree are a well-recognized sequel of massive blunt trauma to the chest, and although unusual, are life threatening. We report a 16-year-old-boy who developed complete disruption of both bronchi after a motor vehicle accident. After induction of general anaesthesia and oral intubation, ventilation could not be maintained, and oxygenation worsened abruptly with peripheral oxygen saturation values less than 60%. Jet ventilation through two intrabronchial catheters, inserted via emergency thoracotomy, raised the saturation from 60% to 100%, and surgery thereafter was straightforward. The anaesthetic management of tracheobronchial repair is discussed.