肺切除术后支气管胸膜瘘的外科治疗

Surgical treatment of Postpneumonectomy associated Bronchopleural Fistula

从1976年至1996年，我科对11例肺切除术后发生支气管胸膜瘘的病人进行了外科治疗。治愈10人，治愈率91％，1例经过3次手术后复发的病人死于与手术无关的晚期肺癌。治疗支气管胸膜瘘的方法很多，以胸改（局部或扩大）加胸部带蒂肌瓣胸内转移方法最有效。肩胂骨次全切除（一种扩大胸改的新术式）加肩胂下肌及冈下肌胸内转移对那些顽固性支气管胸膜瘘病人有良好的效果。作者认为治疗支气管胸膜瘘的关键是：①充分地胸腔引流及感染的控制；②有效地封闭支气管瘘口；③彻底地消除患侧胸膜残腔。

From 1976 to 1996, 11 patients with Postpneumonectomy associated Bronchopleural Fistula (BPF) were treated surglcally. Ten of them were cured and the curative rate was 91 %. One patient underwent three operations whose BPF failed to close died of late period of lung cancer. There were many methods for treating BPF. Thoracoplasty (limited or extensive ) with intratransposition of extrathoracic muscles is a more effective method of treatment. Subtotal resection of scapula with intratransposition of subscapular muscle and musculus infraspinatus is a new surgical procedure and has a good result for treating stubborn recurrent BPF. Authors think that three key points of treating BPF are adequatedrainage of pleural space and contral of infection, effective closure of fistula and complete obliterationresidual pleural space.