The Diagnosis And Management Of Bronchus Pleural Fistula After Lung Cancer Resection

BackgroundWith the development of industrialization, the incidence of lung cancer is rising rapidly, and it has become the highest morbidity and mortality in the world’s all cancer since1985.80%of patients with lung cancer are non-small cell lung cancer (NSCLC), surgery is the main treatment of lung cancer. However, the postoperative complications often occur. Bronchopleural fistula (BPF) is a sinus tract of all levels of the bronchus and pleural cavity. It is one of the most serious complication after lung cancer resection. Reported in the literature, the overall incidence of the BPF is less than1%. The incidence of the BPF after pneumonectomy is the highest, is1%-4%and the mortality is25.0%-79.2%. The BPF is one of the seriouse factors affecting the postoperative outcome. To the treatment of bronchial fistula program remains controversial, yet there is no unified fixed rules. With the surgical techniques and the accumulation of experience, the application of the bronchial stump closure, the prevention of embedded reinforcement of bronchial stump, the incidence of bronchial fistula is lower today, compared with the previous, but it still can not be completely avoided, it causes catastrophic consequences that lead to secondary life-threatening complications and a prolonged hospital stay. The effective prevention and treatment of bronchial fistula is still a challenges facing to all the thoracic surgeons.Objective To investigate and summarize the causes, clinical features, diagnosis and treatment, preventive measures of the BPF after lung cancer resection, in order to enhance the level of the treatment of lung cancer.MothodA retrospective review of patients discharging from our Thoracic Surgery Department of the Second Affiliated Hospital of Zhengzhou University during January2010to December2011. All patients undergone lung cancer resection and the BPF duo to lung cancer are evaluated with our experience and publish literature.ResultThere are226patients evaluated, containing168cases of lobectomy and58cases of pneumonectomy.2patients died of respiratory failure, the perioperative mortality rate was0.88%. There ware3BPF,the incidence is1.33%. There was1BPF in the168cases of lobectomy, the incidence is0.60%; there ware2BPF in the58cases of pneumonectomy, the incidence is3.40%. They ware confirmed by the pleural infusion of methylene blue or fiberoptic bronchoscopy, all ware given thoracic drainage, anti-infection, symptomatic treatment,1cases of lobar resection was self-healing,2cases of indwelling chest tube discharged, patients were followed up for10-16months, all ware alive.ConclutionThe BPF after lung cancer resection is multifactorial, by the progress in the field of surgical techniques, the application of the bronchial stump closure, stump-embedded, the incidence of BPF is lower today, but it is still difficult to avoid completely. To maintain a high degree of vigilance for bronchial fistula, early diagnosis, timely closed thoracic drainage and anti-infection is the key to treatment. Smaller minimally invasive treatment will be the future direction of development of bronchopleural fistula treatment.