Thinking on whether the BPF patients treated by open window thoracostomy after pulmonary resection

Abstract

Objective Introduce the experience of open window thoracostomy in the treatment of bronchopleural fistula after pulmonary resection. To explore which patients are currently suitable for open window thoracostomy, how to deal with them after open window thoracostomy, and how to treat patients without window drainage. Methods In 2017, the thoracic surgery department of Shanghai Pulmonary Hospital completed 13, 341 thoracic surgeries, including 10 cases of open window thoracostomy, and patients with BPF after other pulmonary resection were treated with conservative thoracic closed drainage. Thoracic closed drainage therapy is often accompanied by thoracic irrigation. From January 2004 to December 2017, 21 cases of chronic refractory abscess treated with autologous musculocutaneous flap implantation after pulmonary resection and open window drainage were summarized. The treatment of chronic refractory abscess after 14 years of diagnosis was divided into three stages. The first stage is opening the abscess cavity stage, namely opening the window drainage. The second stage is elimination of abscess cavity and closure of bronchial pleural fistula. The third stage is autologous musculocutaneous flap transplantation or displacement to fill the abscess cavity stage. Results Compared with before open window, the 10 patients with open window thoracostomy showed obvious improvement in thoracic and pulmonary infection, without perioperative death. Other patients with BPF after pulmonary resection without open window thoracostomy died in 2 of conservative thoracic closed drainage. From January 2004 to December 2017, 19 patients(19/21) were successfully treated with autologous musculocutaneous flap implantation after pulmonary resection and open window thoracostomy, without recurrence of empyema and necrosis of skin flap, and 2 cases(2/21) were not cured due to large bronchial fistula, and local recurrence of empyema, without perioperative death. Conclusion Most patients with BPF after pulmonary resection are treated with closed thoracic drainage, especially those with lower lobectomy and with pleural irrigation. Most patients can be cured. If patients with upper lobe, middle and upper lobectomy or pneumonectomy, accompanied by BPF, chest infection and poor drainage, it is easy to develop intrapulmonary infection spreading. We should do open window thoracostomy as soon as possible. The removal of the residual cavity by filling musculocutaneous flap after open window thoracostomy is a great improvement compared with the transthoracic reconstruction. Key words: Open window thoracostomy; Bronchopleural fistula; Chronic refractory pleural empyema