陶文强 等

[摘要] 回顾性分析2例支气管胸膜瘘患者的临床资料并复习文献，2例均发生于肺癌切除术后，根据个体情况分别采用硬化剂、生物蛋白胶封堵瘘口，均一次性封堵成功。经支气管镜治疗支气管胸膜瘘需根据患者个体情况选择封堵材料，瘘口越小者成功率越高。

[关键词] 支气管镜；支气管胸膜瘘；聚桂醇；生物蛋白胶

[中图分类号] R562.2 [文献标识码] C [文章编号] 1673-9701（2015）23-0137-02

Bronchoscopic treatment of two patients with bronchopleural fistula and literature review

TAO Wenqiang ZHOU Wen ZHANG Jinxiang WAN Jianguo

Intensive Care Unit， the Third Affiliated Hospital of Nanchang University， Nanchang 330008，China

[Abstract] To investigate the method of treating bronchopleural fistula by bronchoscopy. The clinical data of two patients with bronchopleural fistula were analyzed retrospectively and the literature was reviewed. Bronchopleural fistula occurred after lung cancer resection in both patients. The hardening agent and biomedical fibrin sealant was used respectively based on the individual situation. The bronchopleural fistula in both patients was sealed one time successfully. In the bronchoscopic treatment of bronchopleural fistula， sealing materials should be chosen based on the patients individual situation. The patients with smaller fistula have higher success rates.

[Key words] Bronchoscopy； Bronchial fistula； Lauromacrogol； Biomedical fibrin sealantlant

支气管胸膜瘘是指肺泡、各级支气管与胸膜腔之间相互交通而形成的瘘管，是肺切除术后的严重并发症之一，发生率3%～28%，病死率16%～72%[1]。随着支气管镜技术广泛应用于临床[2]，经支气管镜治疗支气管胸膜瘘的报道增多[3]。本文现报道2例经支气管镜治疗支气管胸膜瘘患者并复习文献如下。

1 病例资料

病例1：患者为69岁男性，因右肺鳞癌于2012年12月24日行右全肺切除术，术后因感染致呼吸衰竭，给予机械通气、抗感染等治疗，治疗期间可见胸腔闭式引流管内溢出大量气泡，考虑支气管胸膜瘘，行支气管镜检查示：左侧支气管通畅，可见大量脓性分泌物；右侧支气管残端可见一金属丝，残端下方可见一瘘口。胸部CT示：右侧胸腔积液伴积气。于右腋前线第6肋间另置一根胸腔闭式引流管引流出大量脓性液体。给予抗感染、营养支持等治疗，在感染控制后行经支气管镜封堵术：右侧支气管残端上壁黏膜隆起，表面凹凸不平；下壁黏膜光滑完整；中段可见一长约3 mm瘘口（封三图7），注入生理盐水可见气泡，确定瘘口，冲洗清洁后，从支气管镜钳道孔置入专用注射针，在瘘口3、6、9点处注入硬化剂（聚桂醇注射液）0.3 mL、0.3 mL、0.5 mL，即见黏膜隆起封闭瘘口，胸腔闭式引流管无气泡溢出，治疗完成。……