肌瓣或肌皮瓣移植治疗术后难治性脓胸合并支气管胸膜瘘

Treatment of the postoperative refractory empyema with a bronchopleural fistula by a pedicled or free muscle flap transplantation

目的探讨肌瓣或肌皮瓣移植治疗术后难治性脓胸合并支气管胸膜瘘的效果。方法选择2015年7月至2019年12月浙江省立同德医院收治的术后难治性脓胸合并支气管胸膜瘘患者,均经脓胸引流控制感染和(或)介入封堵瘘口,病情基本稳定后行带蒂背阔肌、胸大肌肌瓣或游离股外侧肌肌皮瓣移植填塞脓腔。结果共选择15例患者,男性13例,女性2例,年龄23~83岁,平均61.7岁。患者无围术期死亡,平均随访14.8个月,随访中因肿瘤转移死亡1例,复发小脓腔1例,余13例无支气管胸膜瘘和脓胸复发,肌瓣存活,术后复查胸部CT、MRI显示移植的肌瓣彻底封闭胸膜瘘和填塞脓腔,肌瓣成活率93.33%(14/15),中期治愈率86.67%(13/15)。结论肌瓣、肌皮瓣移植治疗术后难治性脓胸合并支气管胸膜瘘成功率高,效果显著。

Objective To evaluate the safety and clinical efficacy of transplanting a muscle flap to treat the postoperative refractory empyema with a bronchopleural fistula.Methods From July 2015 to December 2019,the clinical data of 15 patients who suffered from postoperative refractory empyema with bronchopleural fistula was retrospectively summarized.There were 13 males and two females with a mean age of 61.7 years.Ten cases had previous posterolateral thoracotomy and four cases underwent minimally invasive surgery.After conservative and endoscopic therapy,a pedicled latissimus dorsi muscle flap,a pectoralis major muscle flap,or a free vastus lateralis myocutaneous flap was harvested from the ipsilateral local thorax or thigh and was transferred to cover the intrathoracic cavity.Results There was no perioperative death.During a mean follow-up of 14.8 months,one patient was dead,one suffered from a recurrence of refractory empyema,and l3 patients had an uneventful course with no recurrence of refractory empyema and bronchopleural fistula.Postoperative chest computed tomography or magnetic resonance imaging showed the empyema cavity was satisfactorily covered with a pedicle or free muscle flap.Conclusions Muscle flap transplantation is an effective alternative for treating the postoperative refractory empyema with bronchopleural fistula,which can achieve promising short-medium-term results.