摘要目的 探讨肺癌全肺切除术后支气管残端瘘的因素,并寻找其预防与治疗方法.方法 回顾性分析1987年5月至2007年5月965例因肺癌行全肺切除术患者中32例术后发生支气管残端瘘患者的临床资料.对全肺切除术后支气管残端瘘的风险因素进行分析.结果 全肺切除术后支气管残端瘘的发生率为3.3%(32/965),左侧12.5%(4/32),右侧87.5%(28/32).单因素分析显示,全肺切除术后支气管残端瘘的风险因素包括右全肺切除、术前接受放疗、延长机械通气、支气管残端长度>2 cm和血清白蛋白<30 g/L.Logistic回归证实右全肺切除、术前接受放疗和血清白蛋白<30 g/L是全肺切除术后支气管残端瘘的危险因素.对直径≤3 mm的瘘口行生物胶粘堵,治愈率为83.3%(5/6).对直径＞3 mm的瘘口行大网膜加固残端,治愈率为83.3%(5/6).结论 右全肺切除、术前接受放疗和血清白蛋白水平低于3 g/L是全肺切除术后支气管残端瘘的危险因素.对直径≤3 mm的瘘口,可应用生物胶粘堵;对直径>3 mm的瘘口,可利用转移大网膜加固残端.

abstractsObjective To analyze the risk factors which influencing the development of bronchopleural fistula (BPF) in pulmonary resections for lung cancer. To clarify the preventive techniques and treatment strategies of BPF. Methods Review the clinical data of 32 patients of postpneumonectomy BPF from 965 patients accepted pneumonectomy for lung cancer from May 1998 to May 2007. Univariate and multivariate analyses were performed by the logistic regression procedure to identify the significant risk factors for BPF in 965 pulmonary resections for lung cancer. Results The prevalence of BPF was 3.3%(32/965). BPF occurred in the right main bronchial stump in 28 patients, left main bronchial stump in 4 patients. The significant risk factors for BPF formation were right pneumonectomy, preoperative irradiation, prolonged mechanical ventilation, bronchial stump more than 2 cm and hypoalbuminemia. Multivariate analysis identified right pneumonectomy, preoperative radiotherapy and hypoalbuminemia as the risk factors of BPF. Successful closure of BPF was achieved in 13 patients (40.6%). The fistula was successfully closed in 5 of 6 patients(83.3%) who had received biologic glues applied bronchoscopically with a fistula less than 3 mm. Pedicled omentum was successfully used for the treatment in 5 of 6 patients with a fistula more than 3 mm. Conclusions Right pneumonectomy, high-dose preoperative radiation therapy, and hypoalbuminemia are risk factors for postpneumonectomy BPF. Biologic glues can be applied bronchoscopically to achieve endobronchial closure of the fistula less than 3 mm. Omentoplasty is useful for the fistula more than 3 mm.