支气管闭合器在肺切除术的应用——附397例经验总结

目的探讨器械缝合法在肺切除术中闭合支气管残端的作用。方法回顾分析638肺切除术患者用器械缝合法闭合支气管残端的疗效。结果全组无支气管胸膜瘘发生,均顺利恢复。结论采用器械缝合法闭合支气管残端省时、安全,能减少术后并发症,明显提高手术疗效。     

无损伤线连续缝合法处理支气管残端

1995年10月至2004年9月我们共施行肺切除术1 896例,其中支气管残端采用结扎或切割缝合器闭合16例,丝线或尼龙线间断缝合750例,采用无损伤线连续往返缝合1 130例,结果后者支气管胸膜瘘和术后早期刺激性咳嗽发生率明显降低,现总结报道如下.     

肺切除支气管无残端成形术治疗周围型肺癌

目的 探讨肺切除支气管无残端成形术治疗周围型肺癌的可行性。方法 167例周围型肺癌患者，行右肺上叶切除术49例，中叶切除术6例，下叶切除术41例，中上叶切除术6例，中下叶切除术5例；左肺上叶切除术32例，下叶切除术28例。肺上叶切断处平中间段支气管外侧壁，肺下叶切断处平肺中叶支气管下缘，肺中下叶切断处平肺上叶支气管下缘。残端采用横形间断缝合。结果 无手术死亡和支气管胸膜瘘发生，支气管切缘癌残留1例。术后随访154例，失访13例。1年、2年和3年生存率分别为98．7％、75．3％和61．3％。结论 周围型肺癌常规采用肺切除支气管无残端成形术，操作简单，不增加手术难度和手术时间。它可减少支气管切缘癌残留和支气管胸膜瘘的发生。     

肺切除术后支气管胸膜瘘的预防与治疗

支气管胸膜瘘 (ｂｒｏｎｃｈｏｐｌｅｕｒａｌｆｉｓｔｕｌａ ,ＢＰＦ)是一种严重的肺切除术后并发症 ,死亡率可达 40 % 〔1-3〕,近年对其预防和治疗取得了一定进展 ,现综述如下。支气管胸膜瘘的发生率解剖性肺切除的普遍开展 ,明显地减低了非解剖性肺切除 (肺门大块结扎、切除 )术后支气管胸膜瘘的发病率。Ａｓａｍｕｒａ等〔1〕 和Ｗｅｉｓｓｂｅｒｇ等〔4〕 总结了手工缝合 (ｍａｎｕａｌｓｕ ｔｕｒｅ)和支气管闭合器 (ｂｒｏｎｃｈｉａｌｓｔａｐｌｅｒ)闭合支气管残端的肺切除术后支气管胸膜瘘的发生率 ,手工缝合为 4%和 4 5 % ,闭合…     

结扎缝合法闭合支气管残端

结扎缝合法闭合支气管残端贺定超秦志端梁景仁自１９８０年至１９９５年我们采用结扎缝合法闭合支气管残端进行肺切除手术１０２０例次，无１例发生支气管胸膜瘘，现介绍如下：临床资料本组中男６９１例，女３２９例。平均年龄４９．６岁。均在全麻下行肺叶或全肺切除术。...     

肺癌全肺切除术后支气管胸膜瘘的处理及预防

目的 探讨全肺切除术后支气管胸膜瘘(BPF)的处理方法及预防原则.方法 回顾性分析1999年7月至2006年6月因肺癌行全肺切除术的815例患者的临床资料.结果 共有15例患者发生BPF,占全部患者的1.8%.右全肺切除后BPF发生率为3.9%,高于左全肺切除患者的0.6%(P＜0.01).支气管切缘见癌组织残留患者BPF发生率为22.7%,高于支气管切缘无癌残留患者的1.3%(P＜0.01).术前接受放疗、化疗患者BPF发生率为5.0%,高于单纯手术患者的1.3%(P＜0.05).76例用自体组织覆盖支气管残端的患者无一发生BPF.全组被确诊为BPF的患者皆予胸腔引流;2例经反复穿刺抽取胸水,胸腔内注入抗生素后痊愈;2例经充分抗炎治疗,高渗盐水冲洗,生物蛋白胶阻塞瘘口后痊愈;6例经单纯闭式引流后病情稳定出院;1例长期开放引流;1例行肌瓣修补瘘口失败,改行高渗盐水反复冲洗后痊愈;3例死于多器官功能衰竭.结论 右全肺切除、切缘癌残留和术前接受放疗、化疗可增加术后BPF的发生率.自体组织覆盖支气管残端是降低BPF发生的有效手段.早期轻型患者可行胸腔穿刺、生物蛋白胶阻塞瘘口和抗生素治疗.及时行胸腔闭式引流、高渗盐水反复冲洗对治疗BPF是非常重要的.     

肺切除机械缝合法闭合支气管断端562例报告

目的探讨应用支气管闭合器机械缝合支气管断端的临床效果和技术要点。方法在562例肺切除术中应用支气管闭合器机械缝合支气管断端。结果全组均未发生支气管胸膜瘘及脓胸,554例均一次成功闭合支气管,仅有8例支气管断端有少许漏气,予以间断加强缝合。结论应用支气管闭合器机械缝合支气管断端临床效果可靠,可以降低支气管胸膜瘘的发生。     

全肺切除术后支气管残端瘘的原因与治疗

目的 探讨肺癌全肺切除术后支气管残端瘘的因素,并寻找其预防与治疗方法.方法 回顾性分析1987年5月至2007年5月965例因肺癌行全肺切除术患者中32例术后发生支气管残端瘘患者的临床资料.对全肺切除术后支气管残端瘘的风险因素进行分析.结果 全肺切除术后支气管残端瘘的发生率为3.3%(32/965),左侧12.5%(4/32),右侧87.5%(28/32).单因素分析显示,全肺切除术后支气管残端瘘的风险因素包括右全肺切除、术前接受放疗、延长机械通气、支气管残端长度>2 cm和血清白蛋白<30 g/L.Logistic回归证实右全肺切除、术前接受放疗和血清白蛋白<30 g/L是全肺切除术后支气管残端瘘的危险因素.对直径≤3 mm的瘘口行生物胶粘堵,治愈率为83.3%(5/6).对直径＞3 mm的瘘口行大网膜加固残端,治愈率为83.3%(5/6).结论 右全肺切除、术前接受放疗和血清白蛋白水平低于3 g/L是全肺切除术后支气管残端瘘的危险因素.对直径≤3 mm的瘘口,可应用生物胶粘堵;对直径>3 mm的瘘口,可利用转移大网膜加固残端.     

肺切除术中支气管残端的处理体会

目的:探讨肺切除术中支气管残端处理的方法及注意事项。方法:对1995年3月～2002年12月肺切除术165例进行回顾性总结分析。结果:30例支气管残端全层间断结节缝合法,术后支气管残端漏3例;35例支气管残端全层结扎法,术后支气管残端漏2例;86例支气管残端全层结扎加全层间断结节缝合法,术后支气管残端漏2例;14例支气管残端闭合器缝合法,术后无支气管残端漏发生。全组无死亡。结论:肺切除术中,支气管残端处理最科学的方法是支气管残端全层结扎加全层间断结节缝合或支气管残端闭合器缝合法。     

器械与丝线缝合支气管和肺动静脉的比较研究

目的 对器械与手工缝合支气管残端和肺动、静脉方法的优缺点进行评价。方法 24条杂种健康成年犬均分2组行左全肺切除。器械组的主支气管残端和肺动、静脉用缝合器缝合;缝线组用丝线按常规手术方法缝合或结扎。术后分别在3、7、15、30d处死动物。对支气管和肺动、静脉残端进行大体和光镜观察,并对犬的生活质量进行观察。结果 缝线粗支气管残端炎细胞浸润明显高于器械组（P＜0．05）。器械组动、静脉无血栓形成,而缝线组有3条犬在肺动、静脉残端处发现小的血栓。结论 器械缝合提高了手术的窀生和规范化,能减少术后并发症。     

Experimental study of the effects of different stapling devices in healing of the mechanically sutured bronchial stump.

OBJECTIVE: The invention of the mechanical suture of the bronchial stump resulted in the significant decrease of the incidence of bronchial fistulas. Bronchial fistula constitutes the most dangerous complication of the pulmonary resection. In connection with some negative opinions in world literature regarding the safety of applying some types of mechanical suture, the multi-factor analysis of efficacy of bronchial stump closure following the total pneumonectomy by two different types of stapling devices was performed. METHODS: The experimental study was performed on 22 sheep. Each sheep underwent left pneumonectomy. In group I the bronchus was closed by the hinged-jaw stapling device (TA-Premium, Auto-Suture). In group II the bronchus was closed by the stapling device of parallel pattern (RLV 30 Ethicon). The macroscopic parameters (i.e. linear structure of staples, degree of staples closure, the symmetry of staples closure in the medial and lateral part of bronchial stump) as well as microscopic parameters (i.e. degree of inflammatory reaction, degree disorder in collagen fibers system, degree of disorders in cartilaginous system, degree of vascular proliferation and nervous regeneration) were evaluated. RESULTS: In three cases of group I the serious abnormalities in staples closure in the medial part of the bronchial stump were revealed. Abnormalities were found also in microscopic evaluation of the specimens. In the whole group the inflammatory reaction predominated in the medial part of bronchial stump near the hinge of the cartridge (P value <0.05). The disorder in the collagen fibers system as well as in the stratified structure of muscular fibers and cartilaginous system was proved. On the other hand, in group II all staples were properly closed in adequate linear structure, without any symmetry in both medial and lateral end of the bronchial stump. The microscopic findings were only the subtle inflammatory process and a slight disarrangement in muscular, collagen and cartilaginous systems. CONCLUSION: The listed abnormalities of mechanical, hinged-jaw suture of bronchial stump seem to be due to the inaccurate placement of staples, their incomplete closure, and excessive damage to the sutured tissues. We conclude that the application of the hinged-jaw mechanical suture of the bronchial stump might result in higher incidence of bronchial fistula after pneumonectomy.     

Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer.

OBJECTIVE: Bronchopleural fistula after pneumonectomy is a very serious complication, occurring in 1-4% of cases, regardless of the bronchial stump closure technique adopted. The objective of this study was to report a bronchial stump closure technique in pneumonectomy by manual suture (polypropylene running suture) and to study the incidence of bronchopleural fistula. METHODS: Between January 1988 and December 1997, 209 patients (186 men and 23 women, mean age = 60.5 years) were operated by the same operator. The indication for surgery was lung cancer in all cases. RESULTS: The incidence of bronchopleural fistula was 2.4%; four fistulas during the first postoperative month and another occurred at 6 months; four were located on the left side and one was situated on the right. The bronchial stulnp was covered in only two of these five cases; 40% died of this complication. Neoadjuvant treatment (chemotherapy and/or radiotherapy) was found to increase the risk of development of bronchopleural fistula (40% vs. 7.2%) and this difference was statistically significant (P = 0.046). CONCLUSIONS: Manual closure of the bronchial stump by running suture, performed on an open bronchus, is a reliable technique with a low incidence of bronchopleural fistula. Those results could be further improved by systematically covering the right and the left bronchial stumps.     

不同闭合方式在降低胰体尾切除术后并发症的效果观察

目的探讨手工缝合和切割闭合器(Endo-GIA stapler)处理胰腺残端对胰体尾切除术后并发症的影响。方法回顾性分析南昌大学第一附属医院2014年1月至2018年8月收治的行胰体尾切除术88例病人的临床资料,根据不同闭合方式分为:手工缝合组24例、开腹闭合器组40例及腹腔镜闭合器组24例,比较三组病人在术中相关指标、术后恢复情况及并发症等方面的差异。结果三组病人在术中出血量、术后住院时间、病理良恶性、住院费用等方面差异均无统计学意义(均P>0.05),三组病人总并发症发生率及胰瘘发生率差异也无统计学意义(P>0.05)。结论切割闭合器与腹腔镜均不能降低胰体尾切除术后总并发症发生率,也不能降低胰瘘发生率。     

Suture closure versus stapling of bronchial stump in 304 lung cancer operations.

Suture closure of the bronchial stump was compared with staple closure after 304 operations for bronchogenic carcinoma over an 8-year period. In 154 cases (112 lobectomies and 42 pneumonectomies) the bronchial stump was closed with interrupted sutures of 000 polyester, and in 150 cases (120 lobectomies and 30 pneumonectomies) an autosuture stapler was used. The time for suture closure ranged from 5-15 minutes, whereas stapling was accomplished uniformly in c. 90 seconds. Bronchopleural fistula developed after suture closure in seven cases (4.5%), but in none after stapling closure. Stapling of the bronchial stump after lobectomy or pneumonectomy for lung cancer is safer and quicker than suture closure, and is recommended as the method of choice.     

Comparison of Two Automatic Staplers for Closing the Bronchial Stump after Pulmonary Resection

The incidence of complications following pulmonary resection using an automatic stapler was studied in 348 consecutive patients. A parallel-jaw stapler with two staple lines was used in group A (133 males, 101 females, mean age 66 years) between 1990 and 1995, and a hinged-jaw stapler with three staple lines in group B (70 males, 44 females, mean age 67 years) in 1995-1997. The incidence of bronchopleural fistula was 0.4% (1 patient) in group A and nil in group B. The incidence of intraoperative air leak requiring interrupted suture closure was 4.7% (11 patients) in group A and nil in group B (p &lt; 0.05). Postoperative bronchopleural fistula did not develop in any of the cases, and there was no mortality. For management of the bronchial stump after pulmonary resection, the newer device firing three rows of staples is superior to the two-row device.     

Comparison of two automatic staplers for closing the bronchial stump after pulmonary resection

The incidence of complications following pulmonary resection using an automatic stapler was studied in 348 consecutive patients. A parallel-jaw stapler with two staple lines was used in group A (133 males, 101 females, mean age 66 years) between 1990 and 1995, and a hinged-jaw stapler with three staple lines in group B (70 males, 44 females, mean age 67 years) in 1995-1997. The incidence of bronchopleural fistula was 0.4% (1 patient) in group A and nil in group B. The incidence of intraoperative air leak requiring interrupted suture closure was 4.7% (11 patients) in group A and nil in group B (p < 0.05). Postoperative bronchopleural fistula did not develop in any of the cases, and there was no mortality. For management of the bronchial stump after pulmonary resection, the newer device firing three rows of staples is superior to the two-row device.     

胰体尾切除术中残端闭合与胰肠吻合的疗效对比

目的 对比胰体尾切除术（distal pancreatectomy,DP）中胰腺残端切闭联合手工缝合与胰腺-空肠端端吻合的疗效。方法 回顾性分析2017年9月至2019年3月昆明医科大学第二附属医院肝胆胰外科三病区收治的64例行胰体尾切除术患者的临床资料。根据胰腺残端处理方式分为两组：残端闭合组：DP术中胰腺使用切割闭合器切闭后联合手工加强缝合（n=30）;胰肠吻合组：DP术中胰腺残端与空肠端端套入式吻合（n=34）。观察指标包括两组的一般资料、胰腺质地、手术时间、术中出血量、术后胰瘘发生率、出血等并发症、总住院天数、费用。结果 64例均手术成功。胰肠吻合组中术后发生胰瘘5例,且均为软胰腺患者;而残端闭合组术后发生胰瘘11例,其中软胰腺7例,硬胰腺4例;胰肠吻合组术后胰瘘发生率明显低于残端闭合组,差异有统计学意义（P＜0.05）;比较两组胰瘘分级、术中出血量、术后出血等并发症,差异无统计学意义（P＞0.05）;另对于两组手术时间、总住院时间、住院总费用的比较,胰肠吻合组均大于残端闭合组,差异有统计学意义（P＜0.05）。结论 DP术中胰腺残端使用胰肠-空肠端端吻合可有效降低术后胰瘘发生率,且对于胰腺质地硬者效果更佳,安全可行,值得推广。