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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2020, Vol. 07 ›› Issue (01) : 40 -43. doi: 10.3877/cma.j.issn.2095-8773.2020.01.007

所属专题： 文献；

论著

支气管胸膜瘘合并难治性脓胸个体化综合治疗分析
何忠良1,†(), 沈立锋2, 徐卫华3, 刘志军1, 陈国兴1, 何雪明1, 伍勇勇1, 辛顺心1   
  1. 1. 310012　浙江省立同德医院心胸外科
    2. 310012　浙江省立同德医院修复重建中心
    3. 310012　浙江省立同德医院呼吸介入科
  • 收稿日期:2019-12-20 出版日期:2020-02-28
  • 通信作者: 何忠良

Analysis of individualized comprehensive therapy for patients with bronchopleural fistula accompanying refractory empyema

Zhongliang He1,†(), Lifeng Shen2, Weihua Xu3, Zhijun Liu1, Guoxing Chen1, Xueming He1, Yongyong Wu1, Shunxin Xin1   

  1. 1. Department of Cardiothoracic and Thoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
    2. Department of Repairing and Reconstructive Centre, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
    3. Department of Interventional Pulmonology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
  • Received:2019-12-20 Published:2020-02-28
  • Corresponding author: Zhongliang He
  • About author:
    Corresponding author: He Zhongliang, Email:
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何忠良, 沈立锋, 徐卫华, 刘志军, 陈国兴, 何雪明, 伍勇勇, 辛顺心. 支气管胸膜瘘合并难治性脓胸个体化综合治疗分析[J]. 中华胸部外科电子杂志, 2020, 07(01): 40-43.

Zhongliang He, Lifeng Shen, Weihua Xu, Zhijun Liu, Guoxing Chen, Xueming He, Yongyong Wu, Shunxin Xin. Analysis of individualized comprehensive therapy for patients with bronchopleural fistula accompanying refractory empyema[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(01): 40-43.

目的

总结和分析支气管胸膜瘘合并难治性脓胸个体化综合治疗的方法和疗效。

方法

2015年7月—2019年11月共收治支气管胸膜瘘合并难治性脓胸患者12例，其中男性10例，女性2例；年龄23～78岁，平均(60.75±15.05)岁。初始手术为非小细胞肺癌4例，肺部良性疾病4例，包裹性胸腔积液3例，恶性胸腺瘤肺转移1例。胸膜瘘发生后，采取经脓胸引流控制感染和介入封堵瘘口治疗；病情基本稳定后，行肌瓣移植术填塞脓腔等综合措施，并根据病情进行个体化治疗。

结果

全组无围手术期死亡病例；在平均17.45个月的随访中，1例患者因肿瘤转移死亡；1例复发小脓腔；其余10例无支气管胸膜瘘和脓胸复发，肌瓣存活，复查胸部CT/MRI显示脓腔被彻底填塞。

结论

对支气管胸膜瘘合并难治性脓胸患者采取个体化综合治疗措施，能达到彻底根治的目的，成功率高，疗效显著，值得推广。

关键词: 支气管胸膜瘘, 难治性脓胸, 综合治疗, 个体化
Objective

To evaluate the safety and clinical efficacy of individualized comprehensive therapy for patients with bronchopleural fistula and refractory empyema.

Methods

From Jul. 2015 to Nov.2019, there were 12 patients with bronchopleural fistula accompanying refractory empyema admitted to our hospital.Their clinical data resulted from thoracic operation and pleural effusion were retrospectively analyzed. Among the 12 , 10 were male and 2 were female (all aged from 23 to 78 , with a median age of (60.75 ±15.05 ) years. And the initial treatment for those 12 patients included 4 cases of non-small cell lung cancer, 4 cases of benign lung disease, 3 cases of encapsulated pleural effusion and 1 case of malignant thymoma with lung metastasis. On the occurrence of pleural fistula , the infection was controlled by empyema drainage and the fistula was blocked by intervention. When the condition was basically stable, muscle flap transplantation and other comprehensive measures were performed to fill the abscess cavity . And individualized treatment was conducted according to the condition.

Results

There was no perioperative death among the whole group. During a mean follow-up of 17.45 months, one patient died of tumor metastasis, one patient had recurrent small pyogenic cavity.And other ten patients had no bronchopleural fistula and abscess chest recurrence, and their muscle flap survived during the follow-up. Postoperative chest CT/MR showed the empyema cavity was satisfactorily obliterated with pedicle or free muscle flaps.

Conclusions

Individualized comprehensive treatment is an effective option for patients with bronchopleural fistula combined with refractory empyema, and may achieve promising short-medium-term results.

Key words: Bronchopleural fistula, Refractory empyema, Comprehensive therapy, Individualization
[1]
Walsh M D, Bruno A D, Onaitis M W, et al. The role of intrathoracic free flaps for chronic empyema[J]．Ann Thorac Surg，2011，91(3)：865-868.
[2]
Zanotti G, Mitchell J D．Bronchopleural fistula and empyema after anatomic lung resection[J]. Thorac Surg Clin, 2015, 25(4)：421-427.
[3]
Cardillo G, Carbone L, Carleo F，et al. The rationale for treatment of postresectional bronchopleural fistula: analysis of 52 patients[J]. Ann Thorac Surg，2015，100(1): 251-257.
[4]
Andreetti C, Menna C, D'Andrilli A，et al.Multi-modal treatment for post pneumonectomy bronchopleural fistula associated with empyema[J]．Ann Thorac Surg，2018，106(6): e337-e339.
[5]
何忠良，张春，沈立峰，等. 游离股外侧肌皮瓣填塞术治疗术后慢性脓胸 [J]．中华胸心血管外科杂志，2016，32(7)：421-422.
[6]
Hong X, He Z, Shen L, et al. Free vastus lateralis musculocutaneous flap transfer for radiation-induced chest wall fistula combined with osteomyelitis: two case report[J]. Medicine(Baltimore)，2019, 98(22): e15859.
[7]
刘志军，何忠良，沈立锋，等. 游离股外侧肌皮瓣移植术治疗慢性脓胸和胸壁窦道[J]. 浙江医学，2019, 41(4)：362-364.
[8]
He X, He Z, Shen L, et al. Free musculocutaneous flap transfer for refractory chronic empyema with chest wall sinus in a 43-old-male with hemophilia A[J]. J Thorac Dis，2018，10(6): E416-E419.
[9]
Hysi H, Rousse N, Claret A, et al.Open window thoracostomy and thoracoplasty to manage 90 postpneumonectomy empyemas[J]. Ann Thorac Surg，2011，92(5)：1833-1839.
[10]
Boudaya M S, Smadhi H, Zribi H, et al. Conservative management of postoperative bronchopleural fistulas[J]. J Thorac Cardiovasc Surg，2013，146(3)：575-579.
[11]
Han X W, Yin M P, Zhu M, et al.Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single-center study of 148 consecutive patients[J]．Surg Endosc，2018，32(10)：4116- 4124.
[12]
Lu C, Feng Z, Ge D, et al. Pedicle muscle flap transposition for chronic empyema with persistent bronchopleural fistula: experience of a single clinical center in China[J]．Surg Today，2016，46(10)：1132-1137.
[13]
Watanabe K, Kiyokawa K, Ino K，et al.Treatment strategies for refractory pulmonary fistulae using a latissimus dorsi mmuscle flap [J]．J Plast Reconstr Aesthet Surg，2011，64(8): 1014-1021.
[14]
Fricke A, Bannasch H, Klein H F, et al. Pedicled and free flaps for intrathoracic fistula management[J]. Eur J Cardiothorac Surg, 2017，52(6)：1211-1217.
[15]
Tsai Y T, Chen C C, Lu H I, et al.Free anterolateral thigh combined flap for chronic postpneumonectomy empyema[J]. Ann Thorac Surg，2010，90(2)：651-654.
[16]
沈立锋，郭峭峰，何忠良，等. 股外侧肌肌瓣移植治疗巨大脓胸三例[J]. 中华整形外科杂志，2018, 34(12): 1044-1048.
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