带蒂胸膜预防高危患者肺叶切除术后支气管胸膜瘘的临床研究

目的研究带蒂胸膜预防高危患者肺叶切除术后支气管胸膜瘘的临床依据。方法以500例接受肺叶切除术的肺癌患者展开回顾性研究,按照治疗方式分为对照组(230例)和研究组(270例)。研究组在切除术后就近切取带蒂胸膜组织制备胸膜片,将胸膜片包绕于患者的支气管残端或者支气管吻合口;对照组在切除术后对残端不做处理。观察并比较2组患者术后支气管胸膜瘘的发生率及发生时间、术后切口感染、胸腔感染情况,按照是否发生支气管胸膜瘘分为A组、B组,分析支气管胸膜瘘发生的相关因素。结果研究组患者术后支气管胸膜瘘、胸腔感染的发生率比对照组患者明显下降,差异具有统计学的意义(P<0.05)。支气管胸膜瘘发生组(A组)患者的应用糖皮质激素、术前放化疗、术中输血、非根治性切除术比例、合并低蛋白血症发生率、感染率和术中出血量比B组患者明显增加,差异具有统计学的意义(P<0.05)。结论使用糖皮质激素、术中输血、合并低蛋白血症、术后感染和术中出血量过高可能为影响肺叶切除术后患者支气管胸膜瘘发生的相关因素,带蒂胸膜包绕残端可有效地预防高危患者肺叶切除术后支气管胸膜瘘的发生,值得临床推行。

Clinical Evidence of Pedicled Pleura on Preventing Bronchopleural Fistula after Lobectomy in High-risk Patients

Objective To study the clinical basis of pedicled pleura on preventing bronchopleural fistula after lobectomy in high-risk patients.Methods A retrospective study was conducted on 500 patients with lung cancer by lobectomy.They were divided into the control group(230 cases)and the research group(270 cases)by the treatment methods.In the study group,the pedicled pleural tissue was cut to prepare the pleural film after the resection,and pleural film was wrapped around the bronchial stump or bronchial anastomosis.The control group didn’t deal with the stump after the resection.The incidence and time of bronchopleural fistula,incision infection and thoracic infection were observed and compared between the 2 groups.Patients were divided into A group and B group,and factors were analyzed.Results The incidence of bronchopleural fistula and thoracic infection in the study group was significantly lower than that of the control group(P<0.05),and proportion of glucocorticoid used,preoperative radiotherapy and chemotherapy,intraoperative blood transfusion,non-radical resection,hypoproteinemia,infection rate and intraoperative bleeding volume in A group were significantly higher than those of B group(P<0.05).Conclusion The use of glucocorticoid,intraoperative blood transfusion,hypoproteinemia,post-operative infection and excessive intraoperative bleeding may be related factors to the occurrence of bronchopleural fistula after lobectomy.Pedicled pleura wrapping stump can effectively prevent the occurrence of bronchopleural fistula in high-risk patients after lobectomy,which is worthy of clinical implementation.