气管支气管胸膜瘘造影检查的临床价值

The Clinical Value of Contrast Examination of Bronchopleural Fistula

目的探讨气管支气管胸膜瘘时检查方法的选择,避免漏诊,指导治疗.方法选择外伤后气管、支气管破裂2例,外科肺叶切除术后支气管残端胸膜瘘3例,1例气管食道瘘,1例左主支气管食道瘘.术前诊断,结合病史、胸片,CT或者支气管纤维镜检查.根据病变部位,选择相应的气管支气管覆膜支架进行封堵治疗.术后雾化吸入,抗炎、对症治疗3～7d.结果外伤性气管支气管破裂胸膜瘘的2例,支架封堵治疗一次获得成功,术后22d顺利取出支架,未出现气管支气管狭窄等并发症;3例因肺叶切除后形成支气管残端胸膜瘘的患者,2例支架封堵治疗获得成功,1例支架封堵治疗后仍有漏存在,最后行一侧肺叶切除.结论对于外伤或者肺叶切除手术导致的气管支气管胸膜瘘的患者,行气管支架封堵治疗成功的条件是术前准确的诊断,而气管支气管造影是众多检查方法中最准确的一种检查.

Objective To expore the suitable method for bronchopleural fistula,to avoid the missed diagnosis and to direct treatment.Methods Two caces of tracheobronchial rupture caused by trauma,3 cases of bronchial stump fistula after the lobectomy surgery of lung,1 case of tracheal esophageal fistula,and 1 case of left main bronchus esophageal fistula were selected in this study. Patients received the preoperative diagnosis combined with the case history,x-ray,CT or bronchofiberscope examination.The homologous tracheobronchial coated-stent was selected to cure according to diseased region.The NEB nebulised medication,anti-inflammatory and symptomatic treatment were given to patients 3～7 days after the operation.Results Two caces of tracheobronchial rupture caused by trauma were successfully cured by the operation of stent closure and the stents were taken out smoothly 22 days after the operation without complications like tracheobronchial stenosis. Two of 3 cases of bronchial stump fistula after the lobectomy of lung＇s surgery were successfully cured by treatment of stent closure,and one case still had fistula after the treatment and then received lobectomy.Conclusion The most important condition for successful treatment of tracheobronchial fistula by trauma or lobectomy with stent closure is accurate preoperative diagnosis.And the tracheobronchography is the most accurate method of many examination methods.