Experience in diagnosis and treatment of bronchopleural fistula after lung resection

doi:10.3877/cma.j.issn.2095-8773.2025.01.04

Abstract

Abstract:

Objective

To summarize the clinical data of bronchopleural fistula （BPF） patients，analyze the causes， and explore the treatment methods and efficacy.

Methods

From April 2021 to June 2024 in Department of Thoracic Surgery，Affiliated Zhongshan Hospital of Dalian Uninersity，6 patients with BPF after lung resection were treated with bronchoscopy （injection of polidocanol around the bronchial fistula） and surgical intervention after the failure of conservative treatment.

Results

Among the 6 patients，4 were males and 2 were females，aged 60 years on average；5 patients underwent right lower lobe resection；3 patients had a long history of smoking；1 patient had diabetes mellitus；3 patients had combined anemia and hypoproteinemia.The mean length of the bronchial stump was （0.8±0.4） cm.The median time to postoperative BPF was 71.5 days.One patient underwent thoracoscopic BPF repair.Five patients were treated with endoscopic injection of sclerosing agent，and one of them had R1 resection，failed endoscopic treatment，and was transferred to surgical repair，with a success rate of interventional therapy of 80%.After follow-up of 3 to 40 months，BPF was healed.

Conclusion

Combining a large amount of relevant research，our group found that BPF after lung resection is related to smoking，malnutrition，right lower lobe surgery，and R1 resection.Endoscopic sclerotherapy is effective，yet surgery remains the final treatment.

Key words: Bronchopleural fistula, Risk factors, Interventional treatment, Surgical repair

Yuhe You, Hongsheng Xue, Wenjun Cao, Liang Wang, Yujie Ma, Zhe Piao, Yanying Wu, Zhilong Zhao. Experience in diagnosis and treatment of bronchopleural fistula after lung resection[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2025, 12(01): 33-38.

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Figures/Tables 3

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参数	病例1	病例2	病例3	病例4	病例5	病例6
年龄（岁）	66	62	68	63	49	52
性别	男	男	女	男	男	女
吸烟史	无	有	无	有	有	无
合并症	有¹	有²	有³	有⁴	无	无
辅助治疗	无	有⁵	无	有⁶	无	无
肿瘤史	有⁷	有⁸	无	无	无	有⁹
白蛋白（g/L）	37.7↓	34.8↓	33↓	47.8	47.4	44.5
血红蛋白（g/L）	127↓	95↓	95↓	153	152	135
白细胞（10⁹/L）	6.3	4.55	3.48↓	10.27↑	6.11	8.2
切除部位	右肺下叶	左肺上叶	右肺下叶背段	右肺下叶	右肺下叶前基底段	右肺下叶后基底段
组织学	间质性肺炎	鳞癌	微浸润腺癌	腺癌	腺癌	腺癌
淋巴结清扫站数	3	11	不详	5	3	0
支气管残端残留	R0	R1	R0	R0	R0	R0
术后BPF发生时间（天）	27	51	90	85	58	88
胸部CT显示瘘口	是	是	否	是	否	否
支气管残端¹⁰（cm）	1.15	1.18	0.52	0.50	0.30	1.20
治疗方法	保守+介入	保守+介入+手术	保守+介入	保守+介入	保守+介入	保守+手术
注射聚桂醇次数	3	1	3	3	2

参数	病例1	病例2	病例3	病例4	病例5	病例6
年龄（岁）	66	62	68	63	49	52
性别	男	男	女	男	男	女
吸烟史	无	有	无	有	有	无
合并症	有¹	有²	有³	有⁴	无	无
辅助治疗	无	有⁵	无	有⁶	无	无
肿瘤史	有⁷	有⁸	无	无	无	有⁹
白蛋白（g/L）	37.7↓	34.8↓	33↓	47.8	47.4	44.5
血红蛋白（g/L）	127↓	95↓	95↓	153	152	135
白细胞（10⁹/L）	6.3	4.55	3.48↓	10.27↑	6.11	8.2
切除部位	右肺下叶	左肺上叶	右肺下叶背段	右肺下叶	右肺下叶前基底段	右肺下叶后基底段
组织学	间质性肺炎	鳞癌	微浸润腺癌	腺癌	腺癌	腺癌
淋巴结清扫站数	3	11	不详	5	3	0
支气管残端残留	R0	R1	R0	R0	R0	R0
术后BPF发生时间（天）	27	51	90	85	58	88
胸部CT显示瘘口	是	是	否	是	否	否
支气管残端¹⁰（cm）	1.15	1.18	0.52	0.50	0.30	1.20
治疗方法	保守+介入	保守+介入+手术	保守+介入	保守+介入	保守+介入	保守+手术
注射聚桂醇次数	3	1	3	3	2

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