Treatment Of Post-pneumonectomy Bronchopleural Fistula By Using Autologous Pedicled Tissue

Bronchopleural fistula is one of the most serious complications afterpneumonectomy. With the development of the surgical techniques and theequipments, and the improvement of the perioperative management, theincidence of bronchopleural fistula after pneumonectomy has dropped to3%,but the mortality still varies from16.4%to71.2%. Local and systemic riskfactors have been proposed in the development of postpneumonectomybronchopleural fistula, the local risk factors include carcinoma at the bronchialstump margin, long bronchial stump, ischemia of bronchial stump, inappro-priate suture of bronchial stump, lung infection, empyema, and preoperativeradiotherapy. The systemic risk factors include nutritional status of patients,long-term and large quantities of smoke, diabetes, sepsis, preoperativeneoadjuvant chemotherapy, glucocorticoid application, and presence ofunderlying lung deseases. Therefore, targeted prevention and treatment of theserisk factors, can reduce the incidence of bronchopleural fistula after pneumon-ectomy. The treatment of bronchopleural fistula includes conservative treatment,bronchoscopic treatment and surgical treatments. Surgical treatments have threemethods, are re-suture of the bronchial stump, application of autologouspedicled tissue, and thoracoplasty. However, at present, there is not an acceptedtreatment standard for bronchopleural fistula. In this article, we review5casesof the treatment of post-pneumonectomy bronchopleural fistula by usingautologous pedicled tissue, to investigate the effect, and advantage of thissurgical method.Objective: To observe the curative efficacy of autologous pedicled tissuein the treatment of post-pneumonectomy bronchopleural fistula. Methods: From2009to2011, there were13cases of post-pneumonectomy bronchopleural fistula in our department,8cases receivedconservative treatment,7cases were cured, and1case died. A total of5caseswere treated by using autologous pedicled tissue,1of those came from otherhospital.2cases were treated by using pedicled pectoralis major,1case waspedicled serratus anterior,1case was pedicled pericardium, and the last1casewas pedicled greater omentum.Results: All the5cases were cured with a cure rate of100%. Thepostoperative hospital stay ranged from9to26days, and16days in average.The Postoperative extubation time ranged from15to35days, and27days inaverage. And there was no case of bronchopleural fistula recurrence.Conclusion: The treatment of post-pneumonectomy bronchopleural fistulaby using autologous pedicled tissue, has a high cure rate， and is anideal treatment. The choice of the autologous pedicled tissue, should depend onthe residual pleural cavity and the volume of pedicled tissue.