A STUDY ON THE METHOD OF TREATMENT FOR BRONCHIAL FISTULA

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Bronchial fistula is one of the most difficult post-operative complications in the surgical treatment for pulmonary tuberculosis, and other severe post-operative complications are often induced by bronchial fistula (Table 1). The results of treatment for bronchial fistula reported in the past literature is not satisfactory (Table 2). Trial was made by the authors to improve the results of treatment. Cases with bronchial fistula undergone surgical treatment in the authors' sanatorium during the period from 1958 to April 1964 were subjected to the study (Table 3). The total number of cases were 43, of which 28 developed bronchial fistula after pulmonary resection performed in our sanatorium, and 15 cases were sent from other hospitals. The method of treatment was divided into the following 3 groups Group A…re-resection of remaining lobe, Group B…re-resection or resuture of bronchus, Group C…cmuscle plom bage with additional thoracoplasty. Group C was subdivided into two, namely Cb and Cc. The former with resuture of bronchus, and the latter without it. The result was best in Group A, next in Groups B and Cb, and worst in Group Cc (Table 6). One case in Group Cb died 1 year and 9 months after the first operation. By post-mortem examination, it was found that the main pulmonary artery was mistaken as Truncus superior, and was amputated at the time of right upper lobe lobectomy. Therefore, this case died not because of bronchial fistula, but mistake of operation technique. The results mentioned above show that the method of suturing bronchus directly when inflamation is over (this was called as 'direct attack' by Mulvihill in the discussion on Murphy's report), is far better than the other methods as the surgical treatment for bronchial fistula. The authors' method used at present for closing bronchial fistula is as follows: Open thora cotomy is done attending not to open the dead space, and the remaining lobe is stripped off from thorax sufficiently. Bronchus is disclosed, and remaining lobe is stripped off upto hilum, thus suture of bronchial wall is made possible. If the bronchus stem is long enough, bronchus is cut off, and if it is short, the edge of fistula is scraped with a sharp curet and resuture is made. Bronchial stump is covered by the remaining lobe, pulmonary ligament is cut if necessary, and the remaining lobe is sutured to the upper thorax wall with several stitches of cutgut. Hematoma between diaphragm and lung often developes by this method, but re-expansion of lung is possible by physical therapy. In conclusion, among 43 cases of bronchial fistula treated at the authors sanatorium, 39 (91%) were cured, 3 (7%) were still hospitalized, and 1 (2%) died. The best result is obtained by the 'direct ataack' on bronchus, and this new method is recommended as the surgical treat ment for bronchial fistula in stead of thoracoplasty with muscle plombage.
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A STUDY ON THE METHOD OF TREATMENT FOR BRONCHIAL FISTULA

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