肺切除术后支气管胸膜瘘的外科治疗

目的探索肺切除术后支气管胸膜瘘(BPF)的外科治疗措施和效果。 方法回顾性分析2000年1月至2013年12月上海市胸科医院收治的27例肺切除术后BPF患者的临床资料，分析其发生时间、原因和治疗措施，并总结治疗效果。 结果行肺切除术患者5010例，共发生27例BPF，发生率为0.5%。其中男性21例，女性6例；年龄31～67岁，平均年龄55岁。9例全肺切除后的BPF患者均首先采用了引流加胸腔内冲洗的方法，其中4例治愈，4例改开放引流，1例行心包胸膜修补瘘口，瘘口愈合，但脓胸一直存在。18例肺叶切除后的BPF患者中，手术后早期发生的BPF有12例，直接用大网膜消灭残腔，瘘口修补6例，完全康复；用肋间肌瓣和前锯肌瓣填塞胸腔、堵塞瘘口6例，其中4例完全一期愈合，2例引流时间较长；另6例BPF患者发生时间晚，且伴有营养缺乏，除局部引流外，改善营养后大网膜消灭残腔后4例均自愈，余2例用肋间肌瓣和前锯肌瓣填塞胸腔，术后胸管引流时间较长后痊愈。 结论BPF能够早期诊断，积极引流和冲洗胸腔是治疗BPF的有效措施，一部分可以自行愈合，而自体组织包括心包胸膜、自体肌瓣和带蒂大网膜等填塞胸内残腔、堵塞瘘口是治疗BPF的最有效办法，其中带蒂大网膜效果最佳。

Surgical treatment of bronchus-pleural fistula after lung resection

ObjectiveTo evaluate the outcomes and surgical management of bronchus-pleural fistula after lung resection. MethodsThe clinical data of 27 patients with bronchus-pleural fistula after lung resection between January 2000 and December 2013 in Shanghai Chest Hospital were retrospectively analysed. The time of disease onset, cause and treatment strategy were investigated, and the outcomes were summarized. ResultsThere were 27 cases (27/5010, 0.5%) of bronchus-pleural fistula after operation, among whom 21 were males and 6 were females. The age ranged between 31 and 67 years, with the mean age of 55 years. Drainage and washing methods were used in 9 cases of fistula after pneumonectomy, among whom 4 recovered completely, 4 transferred to open drainage, and the other one was repaired with pericardium, who suffered from sustained empyema. Among 18 cases of fistula following lobectomy, 12 occurred early after operation.Pedicle omentum was used in 6 of the 12 cases, and complete recovery was achieved. Pedicle muscle flap was used in the other 6 of the 12 cases, primary healing was achieved in 4, while prolonged drainage was done in the other two. The fistula following lobectomy of 6 cases occurred later, with malnutrition. Four of the 6 cases were repaired with omentum, and recovered well after enhanced nutrition. The other two of the 6 cases were repaired with pedicle muscle flap, and recovered after drainage for a longer time. ConclusionsBronchus-pleural fistula is a major complication of thoracic surgery, and early diagnosis and drainage could be very important.Auto-materials for filling the fistula include pedicle muscle flap, pedicle omentum and pericardium, and pedicle omentum may be the better one.