Progress in the diagnosis and treatment of postoperative bronchopleural fistula after lung resection

doi:10.3877/cma.j.issn.2095-8773.2024.04.07

Abstract

Abstract:

Bronchopleural fistula （BPF） is a rare and life-threatening complication after pneumonectomy and is an abnormal passage formed between the bronchial and pleural cavities.BPF allows gases and secretions to be exchanged between the remaining lung and the thoracic cavity，causing coughing，chest tightness and shortness of breath，leading to complications such as pneumonia，pyothorax，and even tension pneumothorax.Because of the low incidence，complex causes，and various forms of BPF，there are few related studies on diagnosis and treatment，and most of them are individual cases.This review combines relevant domestic and foreign studies to introduce the diagnosis and treatment methods and prevention of postoperative BPF，in order to raise awareness and emphasize its importance.

Key words: Bronchopleural fistula, Diagnosis, Treatment

Yuhe You, Yujie Ma, Wenjun Cao, Hongsheng Xue, Zhe Piao, Maoduan You, Xiaoyu Shi, Zhilong Zhao. Progress in the diagnosis and treatment of postoperative bronchopleural fistula after lung resection[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(04): 246-253.

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References 64

1	Grotberg JC，Hyzy RC，De Cardenas J，et al.Bronchopleural Fistula in the Mechanically Ventilated Patient: A Concise Review［J］.Crit Care Med，2021，49（2）：292-301.
2	Salik I，Vashisht R，Sharma S，et al.Bronchopleural Fistula［M］.Treasure Island （FL）：StatPearls Publishing；2024.
3	Jin L，Li Y.Bronchoscopic interventions for bronchopleural fistulas［J］.Ther Adv Respir Dis，2023，17：17534666231164541.
4	Ichinose J，Hashimoto K，Matsuura Y，et al.Risk factors for bronchopleural fistula after lobectomy for lung cancer［J］.J Thorac Dis，2023，15（6）：3330-3338.
5	Wang Y，Zhu M，Pan Y，et al.Long-term follow up and comparison between conservative and interventional therapy in postoperative bronchopleural fistula-a cohort study［J］.J Thorac Dis，2023，15（3）：1210-1216.
6	霍小森，李媛，董延妍，等.气管镜介入治疗肺部手术后发生的支气管胸膜瘘的回顾性分析［J］.中国肺癌杂志，2024，27（3）：187-192.
7	Dugan KC，Laxmanan B，Murgu S，et al.Management of Persistent Air Leaks［J］.Chest，2017，152（2）：417-423.
8	Zhao R，Guan X，Zhang P，et al.Development of postoperative bronchopleural fistula after neoadjuvant immunochemotherapy in non-small cell lung cancer: case reports and review of the literature［J］.J Cancer Res Clin Oncol，2024，150（4）：175.
9	Yang YH，Park SY，Kim HE，et al.Postoperative bronchopleural fistula repair: Surgical outcomes and adverse factors for its success［J］.Thorac Cancer，2022，13（9）：1401-1405.
10	霍小森，李媛，周翠，等.支气管胸膜瘘的临床特征和支气管镜介入治疗的回顾性研究［J］.中国临床医生杂志，2022，50（12）：1471-1473.
11	Peng Z，Mei J，Liu C，et al.Risk factors and outcomes of bronchopleural fistula after bronchoplasty in patients with nonsmall cell lung cancer: a retrospective multivariate analysis［J］.Transl Lung Cancer Res，2022，11（5）：744-756.
12	Fuso L，Varone F，Nachira D，et al.Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula［J］.Lung，2016，194（2）：299-305.
13	Toufektzian L，Patris V，Sepsas E，et al.Does postoperative mechanical ventilation predispose to bronchopleural fistula formation in patients undergoing pneumonectomy？［J］.Interact Cardiovasc Thorac Surg，2015，21（3）：379-382.
14	彭金钊，李晓光.肺癌热消融术后支气管胸膜瘘的研究现状与进展［J］.介入放射学杂志，2020，29（12）：1276-1281.
15	陈智杰，成程，胡剑锋，等.支气管胸膜瘘的多层螺旋CT征象分析［J］.中国临床医学影像杂志，2023，34（5）：327-330.
16	Sakata KK，Reisenauer JS，Kern RM，et al.Persistent air leak -review［J］.Respir Med，2018，137：213-218.
17	吴晓东，唐荣娟，陈荣璋，等.内镜下凡士林纱条封堵治疗支气管瘘的疗效和安全性分析［J］.中华医学杂志，2022，102（44）：3515-3519.
18	Xu W，Chen M，Xu J，et al.A novel approach involving reversed placement of endobronchial valves combined with retrograde methylene blue instillation for the localization of multifocal bronchopleural fistula［J］.Respirol Case Rep，2024，12（2）：e01292.
19	Aldaghlawi F，Kurman JS，Lilly JA，et al.A Systematic Review of Digital vs Analog Drainage for Air Leak After Surgical Resection or Spontaneous Pneumothorax［J］.Chest，2020，157（5）：1346-1353.
20	Amore D，Caterino U，Casazza D，et al.Postoperative Bronchopleural Fistula: A Conservative Way of Treatment in Selected Cases［J］.Thorac Cardiovasc Surg，2021，69（6）：577-579.
21	中国医师协会胸外科医师分会，吴阶平医学基金会肺癌专业委员会，中国抗癌协会肺部肿瘤整合康复专业委员会，等.胸部手术围术期持续性肺漏气管理策略全国专家共识（2023）［J］.中华胸心血管外科杂志，2024，40（4）：193-200.
22	Boudaya MS，Smadhi H，Zribi H，et al.Conservative management of postoperative bronchopleural fistulas［J］.J Thorac Cardiovasc Surg，2013，146（3）：575-579.
23	Grotberg JC，Hyzy RC，De Cardenas J，et al.Bronchopleural Fistula in the Mechanically Ventilated Patient: A Concise Review［J］.Crit Care Med，2021，49（2）：292-301.
24	Liu Z，Mao J，Su M，et al.New treatment of bronchopleural fistula following surgical resection of the dorsal segment of the left lower lobe: A case report［J］.Thorac Cancer，2021，12（3）：382-386.
25	Abramian O，Rosenheck J，Taddeo-Kolman D，et al.Therapeutic closure of bronchopleural fistulas using ethanol［J］.Ther Adv Respir Dis，2021，15：17534666211044411.
26	李洋，张逸远，崔有斌，等.经支气管镜注射硬化剂治疗支气管胸膜瘘22例临床分析［J］.中华外科杂志，2017，55（7）：554-555.
27	Song X，Gu Y，Wang H，et al.The efficacy of endobronchial valves for the treatment of bronchopleural fistula: a single-arm clinical trial［J］.J Thorac Dis，2022，14（3）：712-720.
28	王海，于冬梅，顾晔，等.支气管单向活瓣在支气管胸膜瘘治疗中的效果及安全性分析［J］.中华医学杂志，2022，102（44）：3520-3524.
29	陈伟庄，吴宏成.获得性气道瘘的治疗进展［J］.现代实用医学，2022，34（1）：6-8.
30	李首卓，雷玉洁，赵光强，等.气管支架植入在气道狭窄中的研究新进展［J］.中国医学创新，2022，19（27）：171-175.
31	宋玮，王继旺.经支气管镜置入支气管单向活瓣治疗肺切除术后支气管胸膜瘘2例［J］.中华胸心血管外科杂志，2023，39（11）：678-679.
32	Bossart S，Daneluzzi C，Cazzaniga S，et al.Skin hyperpigmentation after sclerotherapy with polidocanol: A systematic review［J］.J Eur Acad Dermatol Venereol，2023，37（2）：274-283.
33	Qu H，Lei X，Hu L，et al.Successful Endoscopic Sclerotherapy Using Lauromacrogol Injection for Laryngopharyngeal Hemangioma［J］.Ear Nose Throat J，2021，100（9）：662-666.
34	黄志龙，张深燕，方统磊，等.CT导引下聚桂醇硬化治疗肾囊肿［J］.介入放射学杂志，2023，32（11）：1115-1118.
35	杜成刚.经纤维支气管镜黏膜下注射硬化剂治疗支气管胸膜瘘观察［J］.现代临床医学，2013，39（1）：46-47.
36	Zhao P.Progress Report on Interventional Treatment for Bronchopleural Fistula［J］.Emerg Med Int，2023，2023：8615055.
37	覃艳丽，周军.聚桂醇的临床应用及其不良反应［J］.中国介入影像与治疗学，2020，17（9）：569-572.
38	陈波.气道支架在气道疾病中的应用研究进展［J］.现代医药卫生，2023，39（15）：2646-2650.
39	Oki M，Seki Y.A customized， covered metallic stent to repair a postoperative bronchopleural fistula: a promising endobronchial approach［J］.J Thorac Dis，2019，11（4）：1088-1090.
40	柯明耀，吴雪梅.硅酮支架临床应用的创新与探索［J］.中华结核和呼吸杂志，2021，44（12）：1037-1040.
41	陈愉，周子青，冯家欣，等.使用气道内杂交支架治疗复杂气道狭窄和气道瘘疗效与安全性分析［J］.中国肺癌杂志，2020，23（6）：472-478.
42	Li L，Zhang X，Shi J，et al.Airway Stents from Now to the Future： A Narrative Review［J］.Respiration，2023，102（6）：439-448.
43	Stramiello JA，Mohammadzadeh A，Ryan J，et al.The role of bioresorbable intraluminal airway stents in pediatric tracheobronchial obstruction: A systematic review［J］.Int J Pediatr Otorhinolaryngol，2020，139：110405.
44	Hartman JE，Vanfleteren LEGW，van Rikxoort EM，et al.Endobronchial valves for severe emphysema［J］.Eur Respir Rev，2019，28（152）：180121.
45	Toma TP，Kon OM，Oldfield W，et al.Reduction of persistent air leak with endoscopic valve implants［J］.Thorax，2007，62（9）：830-833.
46	李晓.房间隔缺损封堵器、硅胶塞治疗支气管胸膜瘘的可行性分析［D］.长沙：湖南师范大学，2020.
47	谭建龙，陈风雨，欧阳彬，等.经支气管镜置入房间隔缺损封堵器治疗中心型气道胸膜瘘的临床疗效评价［J］.中国呼吸与危重监护杂志，2023，22（6）：403-407.
48	Motus IY，Bazhenov AV，Basyrov RT，et al.Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward？［J］.Interact Cardiovasc Thorac Surg，2020，30（2）：249-254.
49	Bai Y，Li Y，Chi J，et al.Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder：a case series［J］.BMC Pulm Med，2021，21（1）：313.
50	钟志成，陈兢兢，高兴林，等.房间隔封堵器用于治疗支气管胸膜瘘的进展与争议［J］.中华结核和呼吸杂志，2018，41（6）：490-492.
51	Lan T，Luo M，Wei X.Mesenchymal stem/stromal cells in cancer therapy［J］.J Hematol Oncol，2021，14（1）：195.
52	Song N，Scholtemeijer M，Shah K.Mesenchymal Stem Cell Immunomodulation： Mechanisms and Therapeutic Potential［J］.Trends Pharmacol Sci，2020，41（9）：653-664.
53	黄佩，高兴林，钟志成，等.骨髓间充质干细胞治疗支气管胸膜瘘的研究进展.中华结核和呼吸杂志，2019，42（2）：137-140.
54	Bottoni E，Banzatti BP，Novellis P，et al.Endoscopic Lipofilling for the Treatment of Bronchopleural Fistulas After Anatomic Lung Resection［J］.Ann Thorac Surg，2021，111（2）：e143-e145.
55	Marchioni A，Mattioli F，Tonelli R，et al.Endoscopic Bronchopleural Fistula Repair Using Autologous Fat Graft［J］.Ann Thorac Surg，2022，114（5）：e393-e396.
56	李强.气管、支气管瘘的临床诊治现状与展望［J］.中华医学杂志，2022，102（44）：3487-3491.
57	杨晓樽，杨晓军，谢天鹏，等.大网膜胸腔内移植覆盖支气管残端治疗肺切除术后支气管胸膜瘘（附6例报道）［J］.中国肺癌杂志，2018，21（3）：235-238.
58	叶亮，高绍满，管昊琳，等.腹腔镜获取带蒂大网膜在支气管胸膜瘘外科治疗中的应用［J］.中华胸心血管外科杂志，2023，39（4）：234-236.
59	李洋，栾颖，崔有斌，等.全肺切除术后早期支气管胸膜瘘的治疗［J］.中华医学杂志，2016，96（21）：1692-1695.
60	杨继承，袁跃西，钱勇，等.带蒂肋间肌瓣在全肺切除术后早期支气管胸膜瘘中的应用［J］.中国医师杂志，2015，17（5）：746-747.
61	何忠良，沈立锋，徐卫华，等.肌瓣或肌皮瓣移植治疗术后难治性脓胸合并支气管胸膜瘘［J］.中华整形外科杂志，2021，37（11）：1239-1243.
62	Shinohara S，Chikaishi Y，Kuwata T，et al.Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy［J］.J Thorac Dis，2016，8（7）：1697-1703.
63	Skrzypczak PJ，Kasprzyk M，Piwkowski C.The review of the management and prevention methods of bronchopleural fistula in thoracic surgery［J］.J Thorac Dis，2023，15（10）：5268-5271.
64	Hoeijmakers F，Hartemink KJ，Verhagen AF，et al.Variation in incidence， prevention and treatment of persistent air leak after lung cancer surgery［J］.Eur J Cardiothorac Surg，2021，61（1）：110-117.

介入治疗方法	优点	缺点	有效率	适用瘘口直径（mm）
硬化剂	成本低、复发率低、并发症少	不适用于大瘘口、多次介入治疗易复发	76.9%～81.8%^[26，35]	＜5
金属支架	优异的弹性和支撑性，置入过程简单	容易形成肉芽组织，移除难度	89.3%～96.6%^[6，39]	＞5
硅酮支架	生物相容性好、柔软、可塑	稳定性较差、置入较为复杂	94.1%^[40]	＞5
支气管单向活瓣	单向阀结构、置入相对简单	肉芽组织增生、感染、移位、脱落	66.7%～73.1%^[27-28]	＞5
心脏封堵器	生物相容性好、弹性好、气密性好、尺寸可个性化	位移、脱落和气道狭窄	76.9%～93.7%^[47-48]	＞5

介入治疗方法	优点	缺点	有效率	适用瘘口直径（mm）
硬化剂	成本低、复发率低、并发症少	不适用于大瘘口、多次介入治疗易复发	76.9%～81.8%^[26，35]	＜5
金属支架	优异的弹性和支撑性，置入过程简单	容易形成肉芽组织，移除难度	89.3%～96.6%^[6，39]	＞5
硅酮支架	生物相容性好、柔软、可塑	稳定性较差、置入较为复杂	94.1%^[40]	＞5
支气管单向活瓣	单向阀结构、置入相对简单	肉芽组织增生、感染、移位、脱落	66.7%～73.1%^[27-28]	＞5
心脏封堵器	生物相容性好、弹性好、气密性好、尺寸可个性化	位移、脱落和气道狭窄	76.9%～93.7%^[47-48]	＞5

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