肌瓣填塞在治疗全肺切除术后支气管胸膜瘘中的应用

为了评价肌瓣填塞治疗全肺切除术后支气管胸膜瘘（bronchopleural fistula，BPF）的实用性及其疗效，对21例BPF患者，Ⅰ期置胸引管引流感染的脓腔和保护对侧的肺，引流液进行微生物培养，给予抗生素和营养支持。Ⅱ期再开胸，插双腔管保护对侧的肺，搔刮胸腔内坏死组织，显露支气管残端约0．1～0．2cm，脓腔清创，残端封闭，胸外肌瓣转移至胸内，完全包盖闭合的残端，术后抗感染、支持治疗。结果21例患者均用肌瓣转移加强封闭残端，BPF复发2例（2～18d），进行第3次再封闭和肌瓣加强手术，最终，21例BPF成功闭合，3例因多器官功能衰竭于术后1个月死亡。手术死亡率为14．3％（3／21）。平均生存时间3．4年，5年生存率为33．3％（7／21）。初步研究结果提示，带蒂肌瓣是BPF修补和脓腔填塞的理想材料。

Treatment of bronchopleural fistula using pedicle muscle flaps after pneumonectomy

The objective of this study was to analyze the effect of bronchial stump reinforcement with the muscle flap after the complete pulmonary resection.The bronchial stumps of 21 patients were reinforced by an muscle pedicle flap to treat bronchopleural fistula.The initial tube thoracostomy was performed as needed to drain the infected plural space and protect the contralateral lung.The pleural contents were cultured and the antibiotics and nutrition were administered.The thoracostomy was reopend with the contralateral lung protected by a double-lumen tube.After evacuation of the pleural contents and debridement,the broncho-pleural fistula was closed,extrathoracic muscle flap transposition was performed,and the vascularised muscle flap was inserted in the pleural space and stitched onto the bronchi stump.A successful closure was observed in 18 of the 21 patients,but 3 patients died of organ system failure one month after the operation.The recurrence of BPF occurred in 2 patients(2-18 d) who had reoperation and BPF was closed successfully.The 30-day mortality was 14.3%.(3/21) The median disease-free survival was 3.40 years,and the 5-year disease-free survival rate was 33.3%(7/21).In conclusions,well vascularised muscle flap is the best tissue for repair of broncho-pleural fistula.The use of pedicle muscular flap is an efficient method for the closure of bronchopleural fistula after pneumonectomy.