选择性支气管封堵术治疗18例难治性气胸的临床体会

目的 探讨球囊探查加选择性支气管封堵术治疗难治性气胸的疗效、安全性及并发症.方法 选取我院2013年8月至2015年8月期间18例难治性气胸患者,进行球囊探查加选择性支气管封堵术治疗.在常规电子支气管镜检查基础上采用双腔球囊导管对脏层胸膜瘘口所属的引流支气管进行探查定位,然后经双腔导管确认的目标支气管注入不同剂量的自身全血加凝血酶,观察是否成功封堵及相关并发症.结果 16例成功定位引流支气管,2例无法探查到引流支气管.对16例球囊探查成功者顺利施行自体血封堵术,首次封堵成功13例,其中3例于72 h内复发,对该3例行第2次封堵后2例成功,另1例封堵失败患者转入胸外科行手术治疗.封堵术最终成功并顺利拔出胸腔引流管12例,失败4例.在失败的4例中l例患者签字带管出院(跟踪随访半月,胸腔引流瓶内未见气泡逸出,复查胸片提示肺复张,遂拔出胸腔引流管);另外3例未探查到引流支气管,其中2例转入胸外科行手术治疗.结论 球囊探查加选择性支气管封堵术是治疗难治性气胸安全、有效、可行的介入治疗方法.

Clinical study of selective bronchial closure in the treatment of 18 patients with refractory pneumothorax

Objective To disceuse the efficacy complications and safety of exploring balloon combined with the selective bronchial blocking for the treatment of refractory.Methods Performed exploring balloon combined with the selective bronchial blocking for 18 patients with refractory pneumothorax from August 2013 to August 2015 in our hospital.To positioning the drainage bronchus of dirty pleura fistul by double balloon catheter on the basis of conventional electronic bronchoscopy,then injected different doses of whole blood plus thrombin to the target bronchus,observed efficacy and related complications.Results 16 cases were positioned successfully and were implemented smoothly autologous blood closure,13 of them got success in the first block but 3 cases recurrenced during 72 hours,2 cases of them got success during the second block,the 1 cases who was failed in the second block transferred to thoracic surgery for surgical treatment.2 cases of 16 failed to probe into the bronchus.12 cases finally successed in closure at the same time 4 cases failed.1 in 4 cases discharged with tube (review of X-ray suggests pulmonary reexpansion with a half month of follow-up,then pulled out the chest drainage tube);2 case of which did not detect the drainage bronchus received surgical treatment.Conclusions Balloon probe combined selective bronchial closure is safe,effective and feasible intervention methods in the treatment of refractory pneumothorax.