小儿脓胸肺切除后支气管胸膜瘘治疗

目的 探讨小儿脓胸肺切除术后支气管胸膜瘘治疗。方法行肺叶切除术的脓胸患儿61例。经胸腔闭式引流1—2周后，脓腔不能消灭，患侧肺不能膨胀。其中术前支气管胸膜瘘19例，术后出现支气管胸膜瘘6例，术中采用吸出脓液、清理脓苔、纤维板剥离，早期促使余肺完全膨胀，消灭残腔。术后选用敏感抗生素，加强支持疗法，保持有效的胸腔闭式引流。结果术后病理报告：肺囊肿21例（肺泡源性2例，支气管源性17例，多囊肺2例，合并结核感染3例）；肺脓肿38例；肺大泡2例。全部患儿均治愈出院，随访6个月～1年无复发。结论气管胸膜瘘时，正确处理是治愈的关键。

The prevention and treatment of bronchopleural fistula after pneumonoresection due to empyema in children

Objective To investigate the prevention and treatment of bronchopleural fistula after pneumonor esection due to empyema in children, Methods 180 children with empyema who received surgical operation were enrolled in the study. All the patients underwent chest CT, and pleuracentesis confirmed for whole of empyema. After 1 - 2 weeks closed thoracic drainage, vomica couldn＇t be eliminated, lung couldn＇t inflate. Before operation 19 cases had happened bronchopleural fistula, after vomica aspiration, cleaning septic moss, stripping fibrous lamina, 61 cases who underwent routine lobectomy, 6 cases had bronchopleural fistula after operation. Choosing correct surgical approach, making lung fully inflate earlier, eradication of residual cavity, and using sensitive antibiotics, strengthening supportive therapy and maintaining effective closed thoracic drainage could cure the disease. Although thoracoplasty and pedicled colic omentum transplantation was effective in treating bronchopleural fistula, but which was not suitable for children. Results The pathological report after surgery showed there were 21 cases of lung cysts including 2 cases of alveolar endogenous, 17 cases of bronchial endogenous, 2 cases of polycystic lung and 3 cases combined with tuberculosis infection;38 cases of lung abscess;2 cases of lung bubble. All the patients were cured and discharged,with 6 months-1 year follow up, without recurrence case. Conclusion Improper operation or postoperative care is wrong for patients with bronchopleural fistula, and correct treatment is the key to cure.