Wrapping of the Bronchial Stump or Anastomosis with a Pedicled Intercostal Muscle Flap in Operations for Primary Lung Cancer

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Objective: Bronchopleural fistula after pulmonary resection is one of the most serious complications in thoracic surgery. The purpose of this study was to evaluate The efficacy of wrapping of The bronchial stump or anastomosis with a pedicled intercostal muscle flap to avoid this particular problem. Methods: Between January 1996 and December 2000, 365 patients with primary lung cancer underwent pulmonary resection. In 59 patients at high risk for bronchopleural fistula development, prophylactic wrapping of the bronchial stump or anastomosis with a pedicled intercostal muscle flap was performed. The risk factors were as follows: 1. presence of diabetes mellitus, 2. chronic renal failure, 3. previous chemotherapy or radiotherapy, 4. steroid administration, 5. pneumonectomy, sleeve lobectomy, or right middle and lower lobectomy, 6. others. In the remaining 306 patients with no risk factors, none of the bronchial stumps or anastomoses were reinforced. Results: There were 43 men and 16 women. Age ranged from 44 to 82 years(mean 64.8). There were 27 adenocarcinomas, 27 squamous cell carcinomas, 4 small cell carcinomas, and 1 large cell carcinoma. Thirteen patients died late after operation, mainly due to recurrence of carcinoma. There have been no fistulas in the bronchial stumps or anastomoses wrapped with a pedicled intercostal muscle flap(incidence, 0%). In 306 patients with no risk factors, 11 patients developed bronchopleural fistula(incidence, 3.6%)Conclusion: Wrapping of the bronchial stump or anastomosis with a pedicled intercostal muscle flap is a useful, easy and quick technique to avoid bronchopleural fistula after pulmonary resection.
日本呼吸器内視鏡学会の論文
2001-09-25

Wrapping of the Bronchial Stump or Anastomosis with a Pedicled Intercostal Muscle Flap in Operations for Primary Lung Cancer

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