胸腔镜肺叶切除间断缝合联合带蒂心包瓣包埋支气管残端35例

Bronchial stump treated with intermittent suture and pedicled pericardial flap after thoracoscopic lobectomy in 35 cases

目的探讨胸腔镜肺叶切除间断缝合联合带蒂心包瓣包埋支气管残端的临床意义,总结胸腔镜处理支气管残端的经验。方法回顾性分析35例患者胸腔镜肺叶切除支气管残端间断缝合联合带蒂心包瓣包埋的临床资料。距支气管开口约0.5~1 cm切断支气管,残端及周围组织碘伏充分消毒,清除支气管残端分泌物,肿瘤患者支气管残端送快速冰冻为阴性,使用3-0微乔缝线间断缝合支气管切缘,缝合边距约0.4 cm,针距约0.3 cm,加压鼓肺无漏气。"U"游离带蒂心包瓣,大小约4 cm×3 cm,将带蒂心包瓣翻转180°,游离端展开,带蒂心包瓣覆盖支气管残端,使用4-0普通缝线间断缝合带蒂心包瓣与周围组织。结果 35例患者术后平均住院(8.66±2.46)d,术后1个月无支气管胸膜瘘。最后随访时间为2017年9月,无支气管胸膜瘘发生。结论存在支气管胸膜瘘高危因素,器械闭合困难或闭合不安全,胸腔镜下间断缝合联合带蒂心包瓣包埋,采用这种方法术后有效避免支气管胸膜瘘发生,安全有效。

Objective To investigate the clinical significance of bronchial stump treated with intermittent suture and pedicled pericardial flap after thoracoscopic lobectomy and to summarize the experience of thoracoscopic treatment of bronchial stump. Methods The clinical data of 35 patients undergoing interrupted suture and pedicled pericardial flap embedding bronchial stump by thoracoscopic lobectomy were retrospectively analyzed from May 2015 to July 2017 in Zhengzhou University People’s Hospital. The closure equipment have difficulties to pass through thoracoscopic lobectomy bronchus treatment for the lack of space. We dissect bronchus about 0. 5-1 cm away from the bronchial opening,fully disinfect the stump and surrounding tissues by iodophor,and clear the secretion of bronchial stump. Frozen section of bronchial stump tumor samples from patients show negative results. Using 3-0 vicryl suture intermittent suture resection margin of bronchus,the margin of the suture was about 0. 4 cm,the needle gage was about 0. 3 cm,and inflated the lung without leakage. The ＂ U＂ free pedicled pericardial flap,which size was about 4 cm × 3 cm,then rotating the pedicled pericardial flap 180°,expanding the free end,cover the bronchial stump with pedicled pericardial flap,and using the 4-0 ordinary suture interruptly suture pedicled pericardial flap with surrounding tissues. Results The average hospitalization of 35 patients was（ 8. 66 ± 2. 46） days after surgery. No bronchopleural fistula occurred after one month of surgery. The last follow-up time was in September 2017 and no bronchopleural fistula occurred. Conclusion There are high risk for bronchopleural fistula,difficulties of equipment closure or unsecurity of closing. Interrupted suture and pedicled pericardial flap embedding bronchial stump by thoracoscopic is a safe and effective way to avoid the occurrence of bronchopleural fistula after surgery.