捻挫结扎并接近缝合法闭合支气管残端的新技术

捻挫结扎处理阑尾残端的应用价值已得到肯定。U字缝合法可减轻组织的血运和内循环的破坏。但二者同时应用肺切除后闭合支气管残端国内尚未见报道。1　临床资料1.1　 一般资料　我院 1998～ 2 0 0 3年对 2 10例肺切除手术采用了捻挫结扎并用 U字接近缝合的方法闭合支气管残端 2 10例 ,年龄 4 8～ 6 5岁。其中全肺切除术 4 6例 ,肺叶切除术 14 2例 ,肺段切除术 2 2例。病理分类 :恶性肿瘤 (肺癌 14 1例 ) ,感染类疾病 (肺结核 32例 ,肺脓肿 4例 ) ,其他 (肺大疱、错构瘤、畸胎瘤、外伤等 33例 )。术后并发单纯脓胸 5例 ,乳糜胸 1例 ,肺内感染…     

支气管闭合器在肺叶肺段切除手术支气管残端结扎中的应用

目的分析支气管闭合器在肺叶肺段切除手术支气管残端结扎中的应用。方法选取2006年4月—2013年3月我院需要进行肺叶肺段切除手术的患者312例,将其随机分为对照组和治疗组,各156例。对照组采用涤纶线缝扎法进行支气管残端结扎,治疗组采用支气管闭合器进行支气管残端结扎,观察两组并发症发生情况。结果术后治疗组支气管胸膜瘘、胸腔感染、刺激性咳嗽、脓胸及呛咳发生率均低于对照组(P0.05)。结论支气管闭合器用于肺叶肺段切除手术支气管残端结扎可以减少胸腔污染,避免血液反流,结扎闭合可靠,操作简便。     

支气管残端机械缝合的临床应用

2003年1月至2010年12月本院共施行肺切除术718例,全部采用机械缝合处理支气管残端,效果良好,现报道如下。     

左主支气管残端瘘介入封堵一例

患者男性．38岁．因左侧胸膜间皮瘤于2005年2月行手术切除，术后虽经多次化疗．但效果欠佳。2005年7月间皮瘤复发再次行手术切除。手术取左胸外侧切口．入胸后胸内组织广泛粘连，且部分瘤体呈糜烂状，故行间皮瘤及左肺切除术（图1）。术后1d患者出现刺激性咳嗽及呼吸困难，胸部急诊CT扫描考虑左主支气管残端瘘（图2），立即行左胸腔闭式引流术；1周后左胸腔脓胸形成，通过左胸腔闭式引流管观察引流液为咖啡色液体。     

肺癌切除术后支气管胸膜瘘的治疗

支气管胸膜瘘（BPF）是肺切除术后极严重的并发症之一,致残率和病死率均很高。1992-2006年,我科行肺癌肺切除术患者术后发生BPF6例。现报告如下。     

结核性脓胸伴支气管胸膜瘘的围手术期护理

回顾总结本院胸外科1998～2002年结核性脓胸伴支气管胸膜瘘64例在外科治疗的同时，加强围手术期护理疗效。本组64例，男38例，女26例，年龄22～66岁；病变位于右侧4JD例左侧24例，本组病例均为肺结核肺叶切除术后，支气管残端瘘所致脓胸。全组病人均接受不同方式的手术：脓腔闭式引流术64例，胸廓成形术46例，其中I期36例Ⅱ期2例在胸改术同时均采用各种方式的胸膜瘘修补术。[第一段]     

非包埋式保留残端支气管动脉的支气管结扎法行肺切除

我们自１９９３年５月～１９９９年６月改进常用支气管残端结扎法,对３７８例患者采用了保留残端支气管动脉的支气管缝扎法行肺切除,旷置残端不包埋,取得良好效果。介绍如下。对象与方法（１）一般资料：３７８例中男２１４例,女１６４例。年龄２５－６９岁。病程４天～１３年。疾病分类：中央型肺癌１０１例,周围型肺癌８３例,肺结核瘤４８例,结核性毁损肺１６例,支气管扩张症５４例,支气管扩张并大咯血６例,炎性假瘤２２例,中叶综合征７例,肺叶破裂２１例,其它２０例。手术类型：肺叶切除３１２例,全肺切除６６例。（２）手…     

改良支气管残端处理法在肺癌根治术中的应用观察

在132例肺癌患者根治术中用3-0涤纶编织线带线缝合针间断全层缝合加邻近活体组织包埋并涂生物蛋白胶的方法,处理的支气管残端。结果除2例患者术后第10、16天出现刺激性咳嗽外,无其他并发症发生。无1例出现支气管胸膜瘘和死亡。认为本支气管残端处理方法安全可靠,效果良好。     

胆管胸膜支气管瘘二例

胆管胸膜支气管瘘二例蒋江营陈文斌郑树森吴健胡娟英例１患者女性，５８岁。１９９０年１０月２４日入院。患者１９８７年始胆囊炎、胆石症＂反复发作，１９９０年春突然寒战、高热４０℃，右上腹闷胀痛并出现刺激咳嗽，咳出金黄苦水后，闷胀痛减轻。症状于坐位时轻，平...     

Endobronchial closure of bronchopleural fistula using Amplatzer device

Background

Bronchopleural fistulas (BPF) are a dreaded complication after lobectomy and pneumonectomy and are associated with high morbidity and mortality. BPF are treated by a range of surgical and endoscopic techniques. Amplatzer devices (ADs), normally used for the closure of cardiac defects, may enable the minimally invasive occlusion of these defects.

Methods

Three patients with BPF were treated with the bronchoscopic closure of BPF using AD. Under general anaesthesia, the fistula was located using bronchography and the self-expanding AD was placed under direct bronchoscopic and fluoroscopic guidance into the fistula. Bronchography was used to control the complete occlusion of the BPF.

Results

Three male patients with a mean age of 63 years (range, 53-73 years) were successfully treated by AD. Two BPF occurred after lobectomy of the right lower lobe for lung cancer and one after right pneumonectomy for lung cancer. In all patients the bronchoscopic procedure was successful and symptoms of empyema and BPF showed no recurrence over a median follow-up of 22 months.

Conclusions

Endobronchial closure of BPF using AD represents a safe, effective and promising method for postoperative BPF.     

The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer—a cross-sectional study

BackgroundPneumonectomy is a high-risk radical resection procedure, with bronchopleural fistula (BPF) being its most challenging and severe complication. This study aimed to assess the surgical risk factors and the impact of the bronchial stump closure technique on the incidence of the BPF.MethodsThis is a single-center, cross-sectional study of the medical records of 455 post-pneumonectomy patients operated due to non-small cell lung cancer (NSCLC) in 2006–2017. We analyzed the following variables and their influence on the occurrence of the BPF: operation side, surgical techniques (i.e., manual suture or the stapler), stump buttressing, the extension of pneumonectomy, comorbidities, and postoperative complications.ResultsBPF occurred in 7.47% of post-pneumonectomy patients. BPF was more prevalent in right-sided pneumonectomy versus left-sided (10.98% vs. 5.32%; P=0.026). The use of a stapler or manual suture was not associated with the incidence of the BPF (7.96% vs.7.09%, P=0.72). There were no significant differences in the occurrence of BPF among bronchial stump buttressing with the parietal pleura (P=0.80), intercostal muscle flap (IMF) (P=0.46), and pericardial fat pad (P=0.88). When comparing data from 2006–2012 with those from 2013–2017, we found a steady decrease in the number of performed stump reinforcements, but this was not associated with a higher risk of BPF.ConclusionsThe method used for stump closure, additional tissue buttressing of the bronchial stump and year of the surgery had no significant impact on the occurrence of BPF. Only right-sided pneumonectomy was associated with higher BPF occurrence.     

老年慢性阻塞性肺气肿伴发支气管胸膜瘘的外科治疗

目的：探讨老年慢性阻塞性肺气肿伴发支气管胸膜瘘外科治疗的意义,以及一侧肺减容术后肺功能的变化情况。方法：采用肺大泡结扎、缝扎及同侧肺减容术治疗老年慢性阻塞性肺气肿伴发支气管胸膜瘘。结果：手术疗效确切,更重要的是术后肺功能有显著改善。结论：对于老年慢性阻塞性肺气肿伴发支气管胸膜瘘可以行手术治疗,而同时进行的肺减容术可以改善肺功能。     

The efficacy of endobronchial valves for the treatment of bronchopleural fistula: a single-arm clinical trial

BackgroundA bronchopleural fistula (BPF) is defined as communication between the bronchus and pleural cavity, and it is a dreaded complication of severe pulmonary disease. Surgical intervention, pleurodesis, and prolonged chest tube drainage have several disadvantages. To overcome these, many attempts have been made to treat BPF with bronchoscopy, especially with the insertion of an endobronchial one-way valve (EBV). Endobronchial valves for the treatment of BPF which had less trauma, relatively short operation time, better safety, and patients are more likely to accept this operation. If there is a definite efficacy, it should be widely used in later clinical practice. This study aimed to confirm the efficacy of endobronchial valves for the treatment of BPF.MethodsWe retrospectively reviewed data from 26 patients who were treated for BPF using an EBV between August 2017 and October 2020. This sample constitutes all patients treated in our hospital (Shanghai Pulmonary Hospital, Tongji University School of Medicine) for this condition and with this intervention during this timeframe. We collected general information about the patient, complications of the procedure, and chest tube indwelling to assess the efficacy and safety of the procedure.ResultsA total of 26 patients underwent EBV placement procedures; left upper lobe (LUL) was the most common lobe in which the valves were placed. The underlying etiologies for BPF were postoperative BPF (50%; n=14), pneumothorax (15%; n=4), non-tuberculosis mycobacteria (NTM) (19%; n=5), and tuberculosis (12%; n=3). Eleven patients underwent chest tube insertion. The average chest tube duration in the group of patients before receiving valves was 66 days (median, 65 days; range, 14–187 days). The average duration after which the chest tube was removed was 17.5 days after EBV placement (median, 7 days; range, 2–90 days). The effective rate of EBV for the treatment of BPF was 73.1%. Patients for whom the valves were not removed, there were no valve related complications.ConclusionsEBV placement is a relatively mature procedure, which is safe and effective, and generates less trauma and fewer complications. And this intervention may be suitable for wide application in clinical practice.     

Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis

We report a case of a persistent bronchopleural fistula following a pneumonectomy for post-tuberculosis bronchiectasis. The patient had two unsuccessful surgical attempts at closing of the fistula. Further surgical attempts were technically were not possible. Bronchoscopic closure was achieved by injecting human fibrin glue into the fistula via a catheter. Closure of the broncho-pleural fistula was confirmed by repeated ventilation scan over a period of 2 months. Endoscopic closure of small bronchopleural fistulae is an attractive option in children with significant underlying lung disease.     

福建省高致病性禽流感A/H5N1病毒感染并支气管胸膜瘘患者的救治体会

目的 总结重症高致病性禽流感A/H5N1病毒感染(简称人禽流感)患者的临床特点、治疗经验以及合并支气管胸膜瘘的处理方法.方法 对2007年2月福建省建瓯市立医院成功救治的1例重症人禽流感并发右侧支气管胸膜瘘患者的临床资料和诊治过程进行回顾性分析.结果 患者女,44岁,发病前3 d有病死鸡接触史,以发热、气促为主要症状,经呼吸道分泌物检测A/H5N1病毒核酸阳性确诊.患者住院第7天发展为急性呼吸窘迫综合征,病情重、进展快,病程中出现呼吸机相关肺炎、双侧气胸、右侧支气管胸膜瘘等多种并发症.经奥司他韦抗病毒、糖皮质激素抗炎、输注康复期血浆、机械通气、抗感染等治疗,病情有所缓解,但支气管胸膜瘘持续存在并形成脓胸,导致脱机困难.经纤维支气管镜下气囊探查加选择性支气管封堵术、经纤维支气管镜右侧支气管胸膜瘘OB胶粘堵术等介入治疗,患者痊愈,发病第99天出院.结论 人禽流感并发难治性支气管胸膜瘘患者在采取抗病毒、抗感染、机械通气支持、输注康复期血浆等综合治疗的基础上结合介入治疗是可行的.     

胸腔冲洗在结核性支气管胸膜瘘术前治疗中的价值(附68例报告)

回顾性分析2010年1月至2016年12月河北省胸科医院胸外科收治的68例结核性支气管胸膜瘘患者的临床资料。68例患者均给予规律有效的抗结核药物治疗12~18个月,术前均通过胸腔冲洗(根据细菌培养情况给予生理盐水+异烟肼,或生理盐水+左氧氟沙星,或生理盐水+醋酸氯已定)治疗3~12个月,后经单纯胸腔冲洗、胸膜纤维板剥脱术、支气管胸膜瘘修补术、胸廓成形术等方法治疗。结果显示,68例患者经单纯胸腔冲洗瘘口闭合未行手术治疗治愈者7例;行胸膜纤维板剥脱及瘘口修补术治愈20例;行胸廓成形及瘘口修补术治愈38例;长期带管生存3例。对结核性支气管胸膜瘘患者术前应用胸腔冲洗可有效控制胸腔感染,为后期手术创造有利条件。     

Y型一体化自膨式覆膜气道金属支架在胸腔胃-气道瘘中的应用

目的 探讨Y型一体化自膨式覆膜气道金属支架(Y型支架)在胸腔胃-气道瘘治疗中的安全性和疗效.方法 回顾性分析2003年4月到2014年10月郑州大学第一附属医院放射介入科收治的108例胸腔胃-气道瘘患者临床及影像学资料,其中男90例,女18例,年龄41 ～75(60±10)岁.根据瘘口的位置、大小及相关气道直径,个体化设计1～3枚Y型支架(其中跨越隆突区域放置的支架简称大Y支架,跨越叶支气管分叉处放置的简称小Y支架).在X线监视下行病变处气道内支架置入,其中单一大Y支架置入65例、单一小Y支架置入16例、大Y+小Y支架组合置入26例,大Y+双小Y支架组合置入1例.结果 所有患者Y型支架均一次置入成功,104例术后即刻气道和食管造影均未见对比剂进入对侧,瘘口封堵完全,4例置入单Y支架后瘘口封堵不严,后改为大Y+小Y支架置入并封堵完全;术后患者卧位刺激性呛咳症状消失,可正常进食水,生活质量明显提高.术后92例患者获得完整随访,其中59例患者于术后3.1 ～9.0个月死亡,死因包括晚期肿瘤消耗(38例)、恶病质进展(14例)、肺部感染(5例)以及大咯血(2例);4例患者单Y支架置入2 ～10个月后瘘口增大,再次给予1枚Y型支架组合置入并证实瘘口封堵完全;余33例患者存活,生活质量满意.结论 Y型一体化自膨式覆膜金属支架气道内置入能有效封堵胸腔胃-气道瘘,技术可行,近期疗效可靠,能显著提高患者生活质量.     

支气管残端包盖与加固缝合对肺叶切除术后残端愈合的影响

目的分析肺部疾病行肺叶切除术时,支气管残端用两种闭合方法进行处理,其愈合有无差别。方法将2003年3月至2010年3月间入选的247例患者分为两组,一组123例支气管残端行加固处理,即用残端闭合器闭合支气管残端,再用Prolene线连续缝合残端加固;另一组124例在用残端闭合器闭合支气管残端后,用带蒂周围组织覆盖于残端并缝合固定。结果进行残端加固的病例有3例发生支气管胸膜瘘,而用周围组织覆盖组有2例发生,两组P〉0.05。结论肺叶切除术后对支气管残端进行包盖与加固缝合对支气管残端愈合的影响没有差别。