经纤维支气管镜粘膜下注射硬化剂治疗支气管胸膜瘘观察.docVIP

18981862662 duchenggang126@163.com 经纤维支气管镜粘膜下注射硬化剂治疗支气管胸膜瘘的临床疗效分析 杜成刚 四川省大邑县人民医院胸外科611300 【摘要】 目的 探讨经纤维支气管镜粘膜下注射1％乙氧硬化醇治疗肺切除术后支气管胸膜瘘的疗效。方法 13例肺切除术后发生支气管胸膜瘘的患者纳入本次研究，其中男性8例、女性5例，患者平均年龄49.1(39～68)岁。所有患者均接受经纤支镜粘膜下注射1％乙氧硬化醇封闭瘘口的治疗。结果13例支气管胸膜瘘患者瘘口直径2～7mm，平均3.5mm。13例患者中10例获得痊愈，3例治疗失败。10例治疗成功患者平均注射次数为2.1次(1～6次)。注射次数以与瘘口大小有一定的相关性：瘘口＜3mm的7例患者均一次封堵成功，余3例患者注射次数分别为3次、5次和6次。在治疗失败的3例患者中，1例因瘘口较大约7mm×7mm，封堵3次均失败，行带蒂背阔肌移植术后痊愈，l例因硬化剂无法到达瘘口部位，留置永久胸腔引流出院，1例患者硬化剂封堵后再发BPF伴严重胸腔感染，最后发生呼吸衰竭，于术后19d死亡。在经纤维支气管镜硬化剂封堵治疗的过程中未发生严重的并发症及不良反应。结论 纤维支气管镜引导下注射1％乙氧硬化醇治疗支气管胸膜瘘不但可安全、有效的闭合瘘口，而且硬化剂可以重复注射，患者耐受性好且不影响后续治疗。 【关键词】 支气管胸膜瘘; 1％乙氧硬化醇; 内镜下治疗 The clinical outcome of endoscopic submucosal injection of polidocanol for bronchopleural fistula(BPF) after lobectomy [ABSTRACT]Objective To analyze the therapeutic effect of endoscopic submucosal injection of polidocanol for bronchopleural fistula after lobectomy. Methods Totally 13 patients with an average age of 49.1 years(39~68) at time of surgery were included. All patients(8 men and 5 women) with bronchopleural fistula after lobectomy received endoscopic multiple submucosal injection of polidocanol on the margins of the fistula. Results The fistulas ranged from 2mm to 7mm(mean, 3.5mm)in diameter. 10 patients healed successfully, while the other 3 patients failed. Frequency of injection was correlated to the size of orificium fistulae. One-time plugging was successful for 7 patients with less than 3 mm orificium fistulae. However, plugging was performed for 3, 5, 6 times for other 3 successful patients. Among the failed patients, 1 case present large leakage, 1case had the leakage far from the reach of bronchoscope, 1case had severe thoracic infection and died. No therapy-related complications occurred in all patients. Conclusion Endoscopic submucosal injection of polidocanol proved to be a valid and safe method for bronchopleural fistula after lobectomy. [Key Words] bronchopleural fistula; polidocanol; endoscopic treatment 支气管胸膜瘘(BPF)是肺切除术后最严重的并发症之一，病死率可达