| Background and objectivePost-pneumonectomy bronchopleural fistula (BPF) is a severe complication,which refers to the fistula between bronchial and pleural cavity at various levels. BPFis the most lethal complication after lung resection. The study of diagnosis andtreatment in BPF is the research hotspotin recent years.However,ithere was no studyin the animal model of BPF after pneumonectomy.We want to establish a reliable model of Post-pneumonectomy bronchopleuralfistula in rabbits. The objectives of this study is to prevent the happening of the BPFafter pneumonectomy surgery, and to improve the success rate of bronchial stumpfistula in rabbit BPF model, and to explore the mechanism of treating clinic patientsof bronchial stump fistula.Materials and methodsForty-five Japanese big-ear white rabbits were randomly divided into group A(total resection of left lung residual suture,n=15), group B (total resection of leftlung ligation and electrocoagulation,n=15), and group C (sham operated,n=10).Thesamplesvof artery blood were measured at the time of pre-operation and post-opertionimmediately and then1.2.3.4weeks after operation respectively.Chest MSCT scanning was performed at the time of pre-extubation and post-extubation afteroperation.The stoma and the left side of the chest cavity were measured and recored.Bronchography were examined under anesthesia3rdweek after operation, to measurethe sizes of stoma and the left side of the chest cavity. Animals were sacrificed forhistological studies in bronchial stump and the left side of the chest cavity after6weeks. Statistical analysis: All data are expressed as ameans±standard deviation.Using SPSS17.0software, data were compared by one-way ANOVA. Paired t testwas used to compare data before and after surgery. Differences were consideredstatistically significant at P﹤0.05.Results1.The success rate of left pneumonectomy technical was96.7%(29/30).According to the autopsy finding after bronchial stump fistula, The success rate ofrabbit model of bronchial stump fistula was100%(29/29). Pneumonectomy groupsoverall survival was63.3%.The rates of group A and group B were lower than groupC (80.0%). The preoperative body temperatures were statistically significantdiffe-rent in all groups1week after operation (P<0.05); There was no significant different(P<0.05) in each group before and after extubation temperature; A, B groups weresignificantly different before and after extubation (P<0.05).2. There was a significant difference in artery blood-gas in group A and group Bpre-operation compared with post-operation immediately (P<0.01) and nodifference(P>0.05) compared with2ndweek after operation. There was significantdifference in artery blood-gas in group A and group B PaO2, PaCO2levels before andafter extubation arterial blood gas analysis in the lungs resection (P<0.05).3.Diagnostic Imaging: Unplug homemade fistula catheter after surgery, chestMSCT scan and bronchography can be used to diagnose bronchial bronchial stumpfistula. The accuracychest of chest MSCT, and bronchial angiography accuracy were89.7%(26/29) and96.5%(28/29),respectively. 4. Pathological examination: In gross anatomy stump fistula, crater-like, hardsurface with purulent secretions was observed;Left pleural cavity was significantlyreduced, pale yellow, pleural thickening. Light microscopic examination of thebronchial wall mucosa showed partially visible necrosis, mucosa, submucosa andadventitia edema, infiltration of inflammatory cells, mainly neutrophils. Partially,visible angiogenesis and granulation tissue were found. Granulation tissue in group Bwas less than that in group A. Pleurisy hyperplasia, leukocytes, macrophagesinvasion, new hair vessels increased fibroblasts and collagen fibers obvious.ConclusionsAnimal model of bronchial stump fistula can be induced by total excision of theleft lung with catheter colostomy method, which is easy to performed with, lowanimal mortality.This model is similar to patient of BPF morphologically andhistologically,and is valuable in studing BPF clinically. |
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