演題

IS-9-6

Bronchoscopic Polyglycolic Acid Mesh occlusion for postoperative bronchopleural fistura (BPF)

[演者] 山本 真一:1
[著者] 柴野 智毅:1, 峯岸 健太郎:1, 真木 充:1, 光田 清佳:1, 中野 智之:1, 手塚 憲志:1, 遠藤 俊輔:1
1:自治医科大学呼吸器外科

BackgroundBronchopleural fistula (BPF) is one of the most feared complications of lobectomies and pneumonectomies because of the high associated mortality due to becoming aspiration pneumonia with subsequent acute respiratory distress syndrome (ARDS). Surgical interventions may prolong hospitalization and impair postoperative quality of life. Bronchoscopic occlusion allows treatment for inoperable patients such as those with poor physical status. MethodFrom 2009 to 2013, lobectomies and segmentectomies for lung cancer were performed in 720 patients at our institution. Bronchoscopy was performed around postoperative day 7 or immediately if suggestive signs of BPF (fever, hyperleukocytosis, and altered sputum) is present. When the endoscopic finding reveals BPF clearly, we performed bronchoscopic occlusion with PGA mesh consecutively.BPF occurred at the right lower bronchial stump in three patients, superior segmental bronchus of the right lower lobe in three, and intermediate bronchus in one. BPFs of 2 to 3 mm were occluded with polyglycolic acid (PGA) mesh by flexible bronchoscopy in four patients. Larger BPFs were occluded with PGA mesh plus fibrin glue to fix the sheet in five patients. Each procedure was completed upon resolution of air leakage from the chest drainage system.ResultBronchoscopic interventions for BPF were repeated an average of two times. No bronchoscopic procedure-related complications or deaths occurred. Bronchoscopic interventions were successful in all patients.ConclusionBronchoscopic occlusion for BPF with PGA mesh and/or fibrin glue is easy and feasible as the first step of postoperative management.
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