Background: Bronchial pleural fistula (BPF) is a common complication after thoracic surgery for lung resection. Clinical treatment is complex and the effect is poor. The treatment of BPF after lung resection has plagued thoracic surgeons. We reviewed retrospectively the clinical and follow-up data of 6 patients in our hospital who underwent the omentum transplantation in thorax to cover bronchial stump as treatment of BPF after pulmonary resection to analyze why BPF occurs and describe this treatment method. We intend to discuss and evaluate the feasibility, safety and small sample success rate ofthis treatment method.
Methods: During August 2016 to February 2018, six patients in our hospital underwent remedial open thoracotomy and omentum transplantation in pleura space to cover bronchial stump as treatment of bronchopleural fistula after pulmonary resection. Four patients had undergone a prior pneumonectomy and two patients had undergone a prior lobectomy (the residual lungs were resected with the main bronchus cut by endoscopic stapler during the reoperation). The bronchial stumps were sutured by 4-0 string with needle and covered by omentums, which were transplanted in pleura space from the cardiophrenic angle. Postoperatively, the pleura space was irrigated and drained. Summarize the clinical effect and technique learning points.
Results: The patients were all males, aged 61 to 73 years (median age: 66). BPF occurred from postoperative day 10 to 45 (median postoperative day 25). The reoperation was finished in 80 mins-150 mins (median 110 mins). Total blood loss was 200 mL-1,000 mL (median 450 mL). These patients were discharged on postoperative day 12-17 (median 14 days), and there was no more complications associated with bronchopleural fistula. All six patients' bronchial stumps were well closed (100%) and have recovered well during the follow-up period, which lasted 1 month-18 months.
Conclusions: Remedial operation should be performed as soon as possible when BPF after pulmonary resection diagnosed. Excellent prognoses can be achieved by omentum which is easy to get transplanted in thorax to cover bronchial stump as treatment in patients with BPF after pulmonary resection those who can tolerate reoperation.
背景与目的 支气管胸膜瘘（bronchopleural fistula, BPF）是胸外科肺切除术后常见并发症，临床治疗复杂且效果不佳。对于肺切除术后支气管胸膜瘘的处理一直困扰着胸外科医生。总结我院胸外科中心予大网膜胸腔移植覆盖支气管残端治疗肺切除术后出现BPF的临床资料，分析出现BPF的原因，总结外科治疗的方法，探讨其可行性、安全性及小样本的成功率。方法 2016年8月-2018年2月，我中心对接受肺切除术后发生BPF的患者6例，进行再次开胸补救性手术、大网膜胸腔内移植覆盖支气管残端治疗。2例首次手术行肺叶切除（分别为右肺上叶及中下叶切除，再次手术均行患侧残肺切除，直线切割器缝合主支气管），4例首次手术行全肺切除（左右各2例）。术中予4-0微荞线修补主支气管残端后于心膈角处打开膈肌将大网膜移植入胸腔内后覆盖支气管残端。S术后予生理盐水浸泡胸腔。回顾分析上述6例患者的临床资料，总结该术式治疗肺切除术后BPF的临床效果。结果 6例均为男性，中位年龄66岁（61岁-73岁）；术后发生BPF中位时间为术后25天（10天-45天）。再次手术中位时间为110 min（80 min-150 min），术中中位出血量450 mL（200 mL-1,000 mL），再次手术后住院时间中位天数14天（12天-17天）。6例患者术后均恢复良好痊愈出院，支气管残端闭合良好，成功率为100%。随访1个月-18个月各病例均未再出现BPF相关并发症。结论 肺切除术后发生BPF，如患者全身情况尚可耐受手术，应尽早行补救性手术，带蒂大网膜瓣容易获取，胸腔内移植覆盖支气管残端疗效确切可靠，值得临床推广应用。 .
Keywords: Bronchopleural Fistula; Lobectomy; Omentum Transplantation in Thorax; Remedial Operation.