支气管胸膜瘘合并难治性脓胸个体化综合治疗分析

Analysis of individualized comprehensive therapy for patients with bronchopleural fistula accompanying refractory empyema

目的总结和分析支气管胸膜瘘合并难治性脓胸个体化综合治疗的方法和疗效。方法2015年7月—2019年11月共收治支气管胸膜瘘合并难治性脓胸患者12例,其中男性10例,女性2例;年龄23~78岁,平均(60.75±15.05)岁。初始手术为非小细胞肺癌4例,肺部良性疾病4例,包裹性胸腔积液3例,恶性胸腺瘤肺转移1例。胸膜瘘发生后,采取经脓胸引流控制感染和介入封堵瘘口治疗;病情基本稳定后,行肌瓣移植术填塞脓腔等综合措施,并根据病情进行个体化治疗。结果全组无围手术期死亡病例;在平均17.45个月的随访中,1例患者因肿瘤转移死亡;1例复发小脓腔;其余10例无支气管胸膜瘘和脓胸复发,肌瓣存活,复查胸部CT/MRI显示脓腔被彻底填塞。结论对支气管胸膜瘘合并难治性脓胸患者采取个体化综合治疗措施,能达到彻底根治的目的,成功率高,疗效显著,值得推广。

Objective To evaluate the safety and clinical efficacy of individualized comprehensive therapy for patients with bronchopleural fistula and refractory empyema.Methods From Jul.2015 to Nov.2019,there were 12 patients with bronchopleural fistula accompanying refractory empyema admitted to our hospital.Their clinical data resulted from thoracic operation and pleural effusion were retrospectively analyzed.Among the 12,10 were male and 2 were female(all aged from 23 to 78,with a median age of(60.75±15.05)years.And the initial treatment for those 12 patients included 4 cases of non-small cell lung cancer,4 cases of benign lung disease,3 cases of encapsulated pleural effusion and 1 case of malignant thymoma with lung metastasis.On the occurrence of pleural fistula,the infection was controlled by empyema drainage and the fistula was blocked by intervention.When the condition was basically stable,muscle flap transplantation and other comprehensive measures were performed to fill the abscess cavity.And individualized treatment was conducted according to the condition.Results There was no perioperative death among the whole group.During a mean follow-up of 17.45 months,one patient died of tumor metastasis,one patient had recurrent small pyogenic cavity.And other ten patients had no bronchopleural fistula and abscess chest recurrence,and their muscle flap survived during the follow-up.Postoperative chest CT/MR showed the empyema cavity was satisfactorily obliterated with pedicle or free muscle flaps.Conclusions Individualized comprehensive treatment is an effective option for patients with bronchopleural fistula combined with refractory empyema,and may achieve promising short-medium-term results.