CAJ | 학술논문

背景:支气管胸膜瘘传统的治疗主要包括保守治疗和手术治疗两大类.随着内镜介入治疗的发展,一种安全、有效的新方法正引起关注.目的:探讨在支气管镜引导下注射生物蛋白胶联合明胶海绵填塞治疗肺切除术后支气管胸膜瘘的疗效.方法:8例支气管胸膜瘘患者接受经支气管镜微波治疗及明胶海绵填塞后注射生物蛋白胶封堵瘘口的治疗.男6例,女2例,平均年龄为53.8岁(39～73岁).病例7、病例8为左全肺切除,病例1、病例2为左上肺叶切除,病例3为左下肺叶切除,病例4为右下肺叶切除,病例5、病例6为右上肺叶切除.病例4和病例8为术后化疗后出现支气管胸膜瘘的表现.结果与结论:病例8不成功,因瘘口大于5 mm,封堵6次,瘘口未闭,患者放弃治疗而失败,以永久胸腔引流出院.其余7例获得痊愈.注射次数以及住院时间与瘘口大小有一定的联系,瘘口小于3 mm的4例患者均一次封堵成功.而瘘口介于3～5 mm的3例患者注射次数分别为3次和5次.在经支气管镜生物蛋白胶封堵治疗的病例中未发生严重的并发症以及不良反应.说明支气管镜引导注射生物蛋白胶联合明胶海绵和微波治疗支气管胸膜瘘是一种安全、有效的方法.
배경:지기관흉막루전통적치료주요포괄보수치료화수술치료량대류.수착내경개입치료적발전,일충안전、유효적신방법정인기관주.목적:탐토재지기관경인도하주사생물단백효연합명효해면전새치료폐절제술후지기관흉막루적료효.방법:8례지기관흉막루환자접수경지기관경미파치료급명효해면전새후주사생물단백효봉도루구적치료.남6례,녀2례,평균년령위53.8세(39～73세).병례7、병례8위좌전폐절제,병례1、병례2위좌상폐협절제,병례3위좌하폐협절제,병례4위우하폐협절제,병례5、병례6위우상폐협절제.병례4화병례8위술후화료후출현지기관흉막루적표현.결과여결론:병례8불성공,인루구대우5 mm,봉도6차,루구미폐,환자방기치료이실패,이영구흉강인류출원.기여7례획득전유.주사차수이급주원시간여루구대소유일정적련계,루구소우3 mm적4례환자균일차봉도성공.이루구개우3～5 mm적3례환자주사차수분별위3차화5차.재경지기관경생물단백효봉도치료적병례중미발생엄중적병발증이급불량반응.설명지기관경인도주사생물단백효연합명효해면화미파치료지기관흉막루시일충안전、유효적방법.
BACKGROUND: Traditional treatment includes conservative therapy and surgical treatment on bronchial pleural fistula. With the development of endoscopic therapy, a new safe and effective method is concerned. OBJECTIVE: To summarize the therapeutic effect of treating bronchopleural fistula using bronchoscopy-guided injection of fibrin sealant combined with gelatin sponge filled and microwave following after lung resection. METHODS: Totally 8 cases of bronchial fistula patients were received injection of fibrin sealant after microwave and gelatin sponge filled by bronchoscopy, including 6 males and 2 females, mean aged 53.8 years (39-73 year-old). Cases 1 and 2 received left upper pulmonary Iobectomy, cases 3 received left lower pulmonary Iobectorny, case 4 received right lower pulmonary Iobectomy, cases 5 and 6 received right upper pulmonary Iobectomy, and the cases 7 and 8 received pneumonectomy. bronchopleuralfistula occurred after postoperative Chemotherapy in cases 4 and 8. RESULTS AND CONCLUSION: The case 8 was failed to treatment due to the large orificium fistulae (> 5 mm) and disappointed results after 6 times plugging. The other 7 patients were cured successfully. The injection time was correlated to the size of orificium fistulae, and the plugging was successful for 4 patients with less than 3 mm orificium fistulae. However, a third or fifth plugging was performed for 3 cases with 3-5 rnm orificium fistulae. No surgery-related complications occurred in all patients. Bronchoscopy guided injection of fibrin sealant combined with gelatin sponge and microwave is a safe and effective method for bronchial fistula.