摘要
背景与目的 气管镜介入技术作为近年来发展的新技术,具有创伤小、安全性高及可重复性的优点。本研究旨在探讨肺部恶性肿瘤和良性疾病手术后发生的支气管胸膜瘘(bronchopleural fistula,BPF)的临床特征和气管镜下介入治疗的临床疗效,为BPF的防治提供参考方法。方法收集2020年6月至2023年9月北京中医药大学东直门医院呼吸病中心诊治的BPF患者64例,总结BPF发生部位及瘘口特点,并采用气管镜介入治疗。对瘘口较小者(≤5mm)进行黏膜下注射聚桂醇及氰基丙烯酸异丁酯、医用生物蛋白胶或硅胶假体封堵相结合治疗;对瘘口较大者(>5 mm)分别置入不同类型的气道金属覆膜支架和心脏封堵器;观察术前、术后的卡氏体能状态(Karnofsky performance status,KPS)评分、气促评分(shortbreath scale,SS)、体温、胸腔引流液量和白细胞计数。结果64例患者实施全肺、肺叶或肺段切除96个,发生瘘的部位65处,瘘口74个;右肺瘘口数量(63.5%)明显多于左侧(36.5%),且右下叶支气管瘘最为常见(40.5%)。术后患者的KPS评分明显升高,而SS评分、体温、胸腔引流液量和白细胞计数明显降低,与术前比较均有统计学差异(P<0.05)。电话或住院随访1-38个月,中位生存时间为21个月。完全缓解33例(51.6%),临床完全缓解7例(10.9%),部分缓解18例(28.1%),无效6例(9.4%),总有效率为90.6%。结论肺部手术后发生的BPF临床症状较严重,常危及生命,气管镜下介入治疗BPF是一种快速有效的治疗方法。
Background and objective As a new technique developed in recent years,bronchoscopic interven-tion therapy has the advantages of minimal invasion,high safety and repeatability.The aim of this study is to investigate the clinical characteristics of bronchopleural fistula(BPF)induced by surgeries for lung malignancies or benign diseases and the effect of bronchoscopic intervention therapy for BPF,so as to provide support for prevention and treatment of BPF.Methods Data 64 patients with BPF who were treated by bronchoscopic intervention in Respiratory Disease Cen-ter of Dongzhimen Hospital,Beijing University of Chinese Medicine from June 2020 to September 2023 were collected.Patients with fistula diameter≤5 mm were underwent submucous injection of macrogol,combined with blocking therapy with N-butyl cyanoacrylate,medical bioprotein glue or silicone prosthesis.Patients with fistula diameter>5 mm were im-planted with different stents and cardiac occluders.Locations and characteristics of fistulas were summarized,meanwhile,data including Karnofsky performance status(KPS),shortbreath scale(SS),body temperature,pleural drainage volume and white blood cell count before and after operation were observed.Results For all 64 patients,96 anatomic lung resections in-cluding pneumonectomy,lobectomy and segmentectomy were executed and 74 fistulas occurred in 65 fistula locations.The proportion of fistula in the right lung(63.5%)was significantly higher than that in the left(36.5%).Besides,the right inferior lobar bronchial fistula was the most common(40.5%).After operation,KPS was significantly increased,while SS,body tem-perature,pleural drainage volume and white blood cell count were significantly decreased compared to the preoperative values(P<0.05).By telephone follow-up or readmission during 1 month to 38 months after treament,median survival time was 21 months.33 patients(51.6%)showed complete response,7 patients(10.9%)showed complete clinical response,18 patients(28.1%)showed partial response,and 6 patients(9.4%)showed no response.As a whole,the total effective rate of broncho-scopic intervention for BPF was 90.6%.Conclusion BPF induced by pulmonary surgery can lead to severe symptoms and it is usually life-threating.Bronchoscopic intervention therapy is one of the fast and effective therapeutic methods for BPF.
作者
霍小森
李媛
董延妍
边灵杰
安鹏
邹珩
李磊
王洪武
Xiaosen HUO;Yuan LI;Yanyan DONG;Lingjie BIAN;Peng AN;Hang ZOU;Lei LI;Hongwu WANG(Respiratory Disease Center,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 101121,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2024年第3期187-192,共6页
Chinese Journal of Lung Cancer
基金
北京中医药大学基本科研业务费项目(No.2023-JYB-XJSJJ-040)资助。
关键词
肺部手术
支气管胸膜瘘
气管镜介入治疗
Pulmonary surgery
Bronchopleural fistula
Bronchoscopic intervention therapy
