应用房间隔缺损封堵器封堵结核性支气管胸膜瘘的疗效分析

doi:10.3969/j.issn.1009-976X.2020.05.008

摘要/Abstract

摘要： 目的总结分析应用房间隔缺损封堵器封堵结核性支气管胸膜瘘的治疗经验。方法对我科在2018年至2019年20例结核性脓胸伴支气管胸膜瘘病例采用应用房间隔缺损封堵器封堵结核性支气管胸膜瘘的治疗进行回顾性分析。本组病例先行胸廓造口开窗引流术（OWT）换药引流2~4周后,残腔感染有效控制的病人选择行光导纤维气管镜下房间隔封堵器封堵支气管胸膜瘘口。结果全组患者有效地控制胸腔感染后,封堵瘘口治疗后疗效根据临床症状、胸腔及肺部感染控制情况和瘘口闭合情况进行评价,全组20例病例封堵术后达到治愈（CR）标准：瘘口愈合,临床症状完全缓解持续1个月,被封堵器封堵瘘口,临床症状完全缓解持续;随诊6~12个月,其中8例患者封堵术后3~6个月行简单的胸廓关窗术,避免行形体改变大的胸廓改形术,7例患者全身症状改善可耐受择期手术,行余肺切除术+支气管瘘修补术,3例患者部分缓解（partial, PR）,瘘口未闭合,部分被支架封堵,临床症状部分缓解,2例患者出现移位分别在术后8月和术后12月气管镜下取出封堵器。本组患者无死亡病例,围手术期均无不良事件包括封堵器脱落,气道狭窄等并发症发生。结论该治疗方法具有微创及性价比高的特色,因支气管胸膜瘘的瘘管解剖特殊,与房间隔缺损瘘口结构类似,使用房间隔封堵器治疗结核性脓胸伴支气管胸膜瘘在常规治疗无效的情况下,可作为一种在气管镜下特殊治疗技术应用,能快速、有效地封堵瘘口,降低再次感染风险及呼吸衰竭的发生,为结核性脓胸伴支气管胸膜瘘病人提供一个有效治疗方法选择。

关键词: 支气管胸膜瘘, 房间隔缺损封堵器, 结核性脓胸, 胸廓造口术

Abstract: Objective To summarize and analyze the experience of treating tuberculous bronchopleural fistula with atrial septal defect closure device. Methods A retrospective analysis was conducted on the treatment of 20 cases of tuberculous empyema with bronchopleural fistula in our department from 2018 to 2019 using atrial septal defect closure device to block tuberculous bronchopleural fistula. In this group, patients with effective control of residual cavity infection chose fibre-optic subtracheal septum closure device to block the bronchial pleural fistula after fenestration and drainage for 2~4 weeks. Results After effective control of chest infection in the whole group of patients, the efficacy of closure of fistula was evaluated according to clinical symptoms, control of chest and lung infection and closure of fistula. All 20 cases achieved the cure （CR） standard after closure： the fistula healed and the clinical symptoms were completely relieved for 1 month; the patients were followed up for 6~12 months, and 8 patients underwent simple thoracic window closure （OWT） 3~6 months after closure, seven patients had improved systemic symptoms and could tolerate elective surgery. Three patients had partial remission （PR）. The fistula was not closed and partially blocked by stents. The clinical symptoms were partially relieved in 2 patients. The occluder was removed under bronchoscope 8 months and 12 months after operation. There were no death cases in this group, and there were no adverse events in perioperative period, including occluder falling off, airway stenosis and other complications. Conclusion Characterized by minimally invasive and cost-effective, also due to the special anatomy of the fistula of bronchopleural fistula, which is similar to the fistula structure of atrial septal defect. Under the condition that the routine treatment is ineffective, the use of atrial septal defect closure device in the treatment of tuberculosis empyema with bronchopleura fistula can be used as a special treatment technique under tracheoscopy, which can block the fistula quickly and effectively, reduce the risk of re-infection and respiratory failure, and provide an effective treatment for patients with tuberculosis empyema with bronchopleura fistula.

Key words: tuberculous empyema, open window thoracostomy, bronchopleural fistula, occluder for atrial septal defect

中图分类号:

R655

刘家杰, 肖泽林, 高健齐, 连贵勇. 应用房间隔缺损封堵器封堵结核性支气管胸膜瘘的疗效分析[J]. 岭南现代临床外科, 2020, 20(05): 582-587.

LIU Jia-jie, XIAO Ze-lin, GAO Jian-qi, LIAN Gui-yong. Effect of atrial septal defect occluder in the treatment of tuberculous bronchopleural fistula[J]. Lingnan Modern Clinics in Surgery, 2020, 20(05): 582-587.

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