肺切除术后并发支气管胸膜瘘的临床分析

目的分析肺叶或全肺切除术后支气管胸膜瘘的临床诊治经验.方法回顾性分析2003年1月至2010年12月间肺叶或全肺切除术后1 263例患者的临床资料,并发支气管胸膜瘘者(BPF)18例,其中肺癌14例(77.8%),肺结核2例(11.1%),肺毁损2例(11.1%);行左肺叶切除2例(11.1%),左全肺切除6例(33.3%),右肺叶切除2例(11.1%),右全肺切除8例(44.4%).术式:手工缝合12例(66.7%),闭合器缝合6例(33.3%).结果并发患者管胸膜瘘18例中3例经纤维支气管镜注入医用生物蛋白胶治愈,5例行保守治疗,6例行二次开胸瘘口修补,1例患者带胸腔引流管出院,3例患者因并发呼吸衰竭、全身衰竭死亡.结论支气管胸膜瘘是肺叶或全肺切除术后严重的并发症之一,发病原因复杂,治疗困难,预后不佳,关键在于预防.一旦发生,应积极处理.

Clinical Analysis of Bronchopleural Fistula after Lung Resection

Objective To retrospectively analyse the experiences in diagnosis and treatment of bronchoplueral fistula(BPF)after lung resection.Methods 18 patients who underwent lung resection at Yunnan Tumor Hospital from January 2003 to December 2010 sufferred bronchoplucral fistula(BPF).Indications for resection were primary malignancy in 14 patients(77.8%),pulmonary tuberculosis in 2 patients(11.1%),destructive lung in 2 patients(11.1%).Left lobectomy was performed in 2 patients(11.1%),left pneumonectomy in 6 patients(33.3%),right lobectomy in 2 patients(11.1%),right pneumonectomy in 8 patients(44.4%).Surgical method: manual suture in 12 patients(66.7%),and suture closure devices in 6 patients(33.3%).Results Of the 18 patients with bronchoplcural fistula,3 patients were cured with injection of biomedical fibrin glue by fiberoptic bronchoscopy,5 patients underwent conservative treatment,6 patients underwent the reoperation for closure of fistula,1 patient was discharged with a chest tube,3 patients died of respiratory failure and systemic failure.Conclusions Brochopleural fistula after lung resection is a fatal complication with complex etiology,difficult treatment and poor prognosis.When BPF happens,it should be treated actively.