Surgical treatment of bronchus-pleural fistula after lung resection

doi:10.3877/cma.j.issn.2095-8773.2014.01.007

Abstract

Abstract:

Objective

To evaluate the outcomes and surgical management of bronchus-pleural fistula after lung resection.

Methods

The clinical data of 27 patients with bronchus-pleural fistula after lung resection between January 2000 and December 2013 in Shanghai Chest Hospital were retrospectively analysed. The time of disease onset, cause and treatment strategy were investigated, and the outcomes were summarized.

Results

There were 27 cases (27/5010, 0.5%) of bronchus-pleural fistula after operation, among whom 21 were males and 6 were females. The age ranged between 31 and 67 years, with the mean age of 55 years. Drainage and washing methods were used in 9 cases of fistula after pneumonectomy, among whom 4 recovered completely, 4 transferred to open drainage, and the other one was repaired with pericardium, who suffered from sustained empyema. Among 18 cases of fistula following lobectomy, 12 occurred early after operation.Pedicle omentum was used in 6 of the 12 cases, and complete recovery was achieved. Pedicle muscle flap was used in the other 6 of the 12 cases, primary healing was achieved in 4, while prolonged drainage was done in the other two. The fistula following lobectomy of 6 cases occurred later, with malnutrition. Four of the 6 cases were repaired with omentum, and recovered well after enhanced nutrition. The other two of the 6 cases were repaired with pedicle muscle flap, and recovered after drainage for a longer time.

Conclusions

Bronchus-pleural fistula is a major complication of thoracic surgery, and early diagnosis and drainage could be very important.Auto-materials for filling the fistula include pedicle muscle flap, pedicle omentum and pericardium, and pedicle omentum may be the better one.

Key words: Lung resection, bronchus-pleural fistula, Surgical treatment, Muscle flap, Pedicle omentum

Jia Huang, Qiang Tan, Hao Lin, Liqiang Qian, Peiji Lu, Zhengping Ding, Qingquan Luo. Surgical treatment of bronchus-pleural fistula after lung resection[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2014, 01(01): 30-34.

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References 16

[1]	Taghavi S, Marta GM, Lang G, et al. Bronchial stump coverage with a pedicled pericardial flap：an effective method for prevention of postpneumonectomy bronchopleuralfistula [J] . Ann Thorac Surg, 2005，79 (1) ：284-288.
[2]	Hanaoka T, Nakajima Y, Shiraishi Y, et al. Transposition of modified latissimus dorsi musculocutaneous flap in the treatment of persistent bronchopleural fistula after posterolateral incision[J]. Jpn J Thorac Cardiovasc Surg，2004，52(2)：84-87.
[3]	Walser EM, Gomez G, Zwischenberger JB，et al.Combined transthoracic and transtracheal closure of large bronchopleural fistulae [J]. J Laparoendosc Adv Surg Tech A, 2004，14 (2)：97-101.
[4]	al-Kattan K, Cattalani L, Goldstraw P. Bronchopleural fistula after pneumonectomy a hand suture technique[J]．Ann Thorac，1994，58：1433-1436.
[5]	Hanaoka T, Nakajima Y, Shiraishi Y，et al.Transposition of modified latissimus dorsi musculocutaneous flap in the treatment of persistent bronchopleural fistula after pos terolateral incision[J]. Jpn J Thorac Card iovasc Surg，2004，52( 2): 84-87.
[6]	Asanaura H, Kondo H, Tsuchiya R，et al. Management of the bronchialstumpinpulmonary：are view of 533 Consecutive recent bronchial closures[J]．Eur J Cardiothorac Surg，2000，17(2)：106-110.
[7]	Vanni B, Alber ToA, Alessandro B，et al.Transternal approach tochosurre of bronchopleural fistulas after pheumonectomy：a fifteen cases report[J]．Lung Cancer，2000，29(1)：43-47.
[8]	Mendel T, Jakubetz J, Steen M，et al.Post-lobectomy bronchopleural fistula—a challenge for postoperative intensive care[J]. Anasthesiol Inten-sivmed Notfallmed Schmerzther, 2006, 41(4): 278-83.
[9]	Wright CD, Wain JC, Mathisen DJ, et al. Post-pneumonectomy bronchopleural fistula after sutured bronchial closure: incidence, risk factors, and management[J]. J Thorac Cardiovask Surg，1996，112: 1367-1371.
[10]	World Health Organization. Anti-tuberculosis drug resistance in the world. Report no.The WHO/IUATLD global project on anti-tuberculosis resistant surveillance 1999-2002[M]．Geneva：World Health Organization, 2004.
[11]	Hubaut JJ, Baron O, AI Hahash O，et al. Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer[J]. Eur J Cardiothorac Surg，1999，16(4)：418-423.
[12]	Pairolero PC, Trastek VF, Allen MS. Empyema and bronchopleural fistula[J]．Ann Thorac Surg，1991，51(1)：157-158.
[13]	Asamura H, Naruke T, Tsuchiya R, et al. Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome[J]. J Thorac Cardiovasc Surg, 1992，104(5)：1456-1464.
[14]	Hamid UI, Jone JM. Closure of a bronchopleural fistula using glue[J]．Interact Cardiovasc Thocrcic Surg，2011，13(2)：117-118.
[15]	Gao YS, Meng PJ, He J．The risk factors and treatment of bronchopleural fistula after pneumonectomy[J]. Zhonghua Wai Ke Za Zhi, 2008，46(9)：667-669.
[16]	D′Andrilli A, Ibrahim M, Andreetti C, et al.Transdiaphragmatic harvesting of the omentum through thoracotomy for bronchial stump reinforcement[J]. Ann Thorac Surg, 2009，88(1)：212-215.

手术方式		总例数	BPF
手术方式		总例数	例数	百分率
肺叶切除		4580	18	3.90
?	左侧	1969	1	0.05
?	右侧	2611	17	6.50
全肺切除		305	9	3.00
?	左侧	204	1	0.50
?	右侧	101	8	7.90
袖型切除		125	0	0.00
?	左侧	36	0	0.00
?	右侧	89	0	0.00

手术方式		总例数	BPF
手术方式		总例数	例数	百分率
肺叶切除		4580	18	3.90
?	左侧	1969	1	0.05
?	右侧	2611	17	6.50
全肺切除		305	9	3.00
?	左侧	204	1	0.50
?	右侧	101	8	7.90
袖型切除		125	0	0.00
?	左侧	36	0	0.00
?	右侧	89	0	0.00

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