Tre treatment for postpneumonectomy bronchopleural fistula; possible role of omentoplasty

概要

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Pneumonectomy was performed at our facility 104 times from April 1978 to March 1992. Postoperative bronchopleural fistulas occurred in 11 (10.6%) patients, significantly more often (p = 0.017) on the right side than on the left, but there was no correlation with the disease type. Bronchopleural fistula occurred within the first postoperative week in 5 patients and within the first postoperative month in all 11 patients. Four patients (36.4%) died and 7 patients were managed successfully. An omental pedicle was effective and successful in all 5 patients in whom it was used (omentoplasty). In patients without infection, satisfactory results were obtained by single-stage resuture of the fistula and omentoplasty. Infected patients were managed succssfully after sterilization of the empyema cavity by open theracotomy followed by omentoplasty without thoracoplasty. When infection could not be controlled, omentoplasty combined with thoracoplasty and myoplasty were successful. Patients with bronchopleural fistula following pneumonectomy died without exception when treatment failed, suggesting that it is necessary to perform extensive surgery with the use of an omental pedicle.
特定非営利活動法人日本呼吸器外科学会の論文