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肺癌全肺切除术后支气管胸膜瘘的处理及预防

Treatment and prevention of bronchus-pleural fistula after pneumonectomy for lung cancer

摘要:

目的 探讨全肺切除术后支气管胸膜瘘(BPF)的处理方法及预防原则.方法 回顾性分析1999年7月至2006年6月因肺癌行全肺切除术的815例患者的临床资料.结果 共有15例患者发生BPF,占全部患者的1.8%.右全肺切除后BPF发生率为3.9%,高于左全肺切除患者的0.6%(P<0.01).支气管切缘见癌组织残留患者BPF发生率为22.7%,高于支气管切缘无癌残留患者的1.3%(P<0.01).术前接受放疗、化疗患者BPF发生率为5.0%,高于单纯手术患者的1.3%(P<0.05).76例用自体组织覆盖支气管残端的患者无一发生BPF.全组被确诊为BPF的患者皆予胸腔引流;2例经反复穿刺抽取胸水,胸腔内注入抗生素后痊愈;2例经充分抗炎治疗,高渗盐水冲洗,生物蛋白胶阻塞瘘口后痊愈;6例经单纯闭式引流后病情稳定出院;1例长期开放引流;1例行肌瓣修补瘘口失败,改行高渗盐水反复冲洗后痊愈;3例死于多器官功能衰竭.结论 右全肺切除、切缘癌残留和术前接受放疗、化疗可增加术后BPF的发生率.自体组织覆盖支气管残端是降低BPF发生的有效手段.早期轻型患者可行胸腔穿刺、生物蛋白胶阻塞瘘口和抗生素治疗.及时行胸腔闭式引流、高渗盐水反复冲洗对治疗BPF是非常重要的.

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abstracts:

Objective To explore the methods of the treatment and the principles of the prevention of bronchus-pleural fistula(BPF)after pneumonectomy.Methods The clinical data of 15 cases of BPF after pneumonectomy in 815 lung cancer cases treated from July 1999 to June 2006 were analyzed retrospectively.Results The occurrence rate of BPF after right pneumonectomy was 3.9%(12/310),higher than 0.6%(3/505)of left pneumonectomy(P<0.01).The occurrence rate of BPF in cases with positive cancer residues in stump of bronchus was 22.7%(5/22),higher than 1.3%(10/793)of the cases with negative stump of bronchus(P<0.01).The occurrence rate of BPF in the cases received preoperative radio-or chemotherapy was 5.0%(6/119),higher than 1.3%(9/696)of the cases received operation only(P<0.05).There were no BPF occurred in the 76 cases whose bronchial stump were covered with autogenous tissues.Au of the cases diagnosed as BPF were undertaken either closed or open chest drainage.Two cases were cured by thoracentesis aspiration and infusion antibiotics repeatedly.Two cases were cured by blocking the fistula with fibrin glue after sufficient anti-inflammatory treatment and hypertonic saline flushing.Six cases were discharged with a stable condition after closed drainage only.One case was discharged with open drainage for long time and 1 case was cured by hypertonie saline flushing after failure to cover the BPF using muscle flaps.Three cases died of multi-organs functional failure.Conclusions BPF are retated to the bronchial stump management and positive or negative residue of tumor at the bronchial stump.Autogenous tissues covering of the bronchial stump is a effective method for decrease the rate of BPF and especially for those patients received preoperative radio-or chemotherapy and right pneumonectomy.It should be performed for early mild cases with repeated thoracentesis aspirations or blocking the fistula with fibrin glue together with antibiotics.Chest closed drainage immediately and flushing with hypertonic saline repeatedly are effective methods for BPF.

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作者: 王大力 [1] 程贵余 [1] 孙克林 [1] 孟平均 [1] 方德康 [1] 赫捷 [1]
第一作者: 王大力
期刊: 《中华外科杂志》2008年46卷3期 193-195页 MEDLINEISTICPKUCSCD
分类号: R73
栏目名称: 论著
DOI: 10.3321/j.issn:0529-5815.2008.03.012
发布时间: 2008-06-04
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