Backgrounds: Our goal is to evaluate the correct management of broncho-pleural fistula (BPF) after lobectomy for lung cancer. Methods: We retrospectively reviewed our 25-years’ experience and reported our strategies and our diagnostic algorithm for the management of post-lobectomy broncho-pleural fistula. Results: Five thousand one hundred and fifty (5150) patients underwent lobectomy for lung cancer in the period between 1998 and 2023. A total of 44 (0.85%) out of 5150 developed post-operative BPF. In 11 cases, BPF was solved by non-invasive treatment. In nine cases, direct surgical repair of the bronchial stump allowed BPF resolution. In 14 cases, a completion intervention was performed. In six cases, we performed open window thoracostomy (OWT) after lobectomy; in two cases, the BPF was closed by percutaneous injection of an n-butyl cyanoacrylate glue mixture. In two cases, no surgical procedure was performed because of the clinical status of the patient at the time of fistula developing. Thirty-day and ninety-day mortality from fistula onset was, respectively, 18.2% (eight patients) and 22.7% (ten patients). Thirty-day and ninety-day mortality after completion pneumonectomy (12 patients) was, respectively, 8.3% (one patient) and 16.6% (two patients). Conclusions: The correct management of BPF depends on various factors: timing of onset, size of the fistula, anatomic localization, and the general condition of the patient. In the case of failure of various initial therapeutic approaches, completion intervention or OWT could be considered.
背景：本研究旨在评估肺癌肺叶切除术后支气管胸膜瘘（BPF）的正确处理方法。方法：我们回顾性分析了25年来的临床经验，并报告了肺叶切除术后支气管胸膜瘘的处理策略及诊断流程。结果：1998年至2023年间，共有5150例患者因肺癌接受肺叶切除术，其中44例（0.85%）术后发生支气管胸膜瘘。11例患者通过非侵入性治疗成功解决瘘口；9例通过直接手术修补支气管残端实现瘘口闭合；14例接受了全肺切除术；6例在肺叶切除后行开放窗口胸廓造口术；2例通过经皮注射氰基丙烯酸正丁酯混合胶封闭瘘口；另有2例因瘘发生时患者临床状况未行手术治疗。瘘发生后30天和90天死亡率分别为18.2%（8例）和22.7%（10例）。全肺切除术（12例）后30天和90天死亡率分别为8.3%（1例）和16.6%（2例）。结论：支气管胸膜瘘的正确处理取决于多种因素：瘘发生时间、瘘口大小、解剖位置及患者全身状况。若初始治疗方案无效，可考虑全肺切除术或开放窗口胸廓造口术。
肿瘤(癌症)患者之家