Abstract
ObjectiveTo investigate the efficacy of carbolic acid treatment of bronchopleural fistula (BPF) using bronchofiberscope (BFS) in post-pulmonectomy patients.MethodTwelve patients with post-pulmonectomy BPF were enrolled in this study at the Liaoning Tumor Hospital between February 2009 and March 2012. Three patients had BPF after the right pneumonectomy, six patients after left pneumonectomy, one patient after the right middle and low lobectomy and two patients after left upper lobectomy. BPF patients were instilled with 100 % carbolic acid (0.5–1 ml one time every week) through BFS on the mucosal surface around the fistula, and the bubble disappearance was monitored. Treatment was repeated if the bubble remained.ResultsNo haemorrhage, severe dyspnea or SpO2 declines occurred in all the 12 patients during the bronchoscopic therapy. BPF orifices were closed in five patients after receiving 5 treatments with carbolic acid, 1 patient received 2 treatments, 1 patient was given 3 treatments, 2 patients received 4 treatments and 3 patients were given 7 treatments. Follow-up was conducted for six months following bronchoscopy. The average treatment and fistula closure time were calculated from the data collected as 20 min and 30 days, respectively, and the cure rate was 100 %. Hematoxylin-eosin (HE) staining results revealed that the white flat hyperplasia tissue after carbolic acid treatment was inflammatory granulation tissue.ConclusionOur results revealed that instillation of 100 % carbolic acid with BFS to treat BPF was 100 % effective, which can be a support for post-pulmonectomy BPF.
Highlights
Bronchopleural fistula (BPF) is a relatively infrequent but potentially fatal complication of pulmonary resection
BPF orifices were closed in five patients after receiving 5 treatments with carbolic acid, 1 patient received 2 treatments, 1 patient was given 3 treatments, 2 patients received 4 treatments and 3 patients were given 7 treatments
Our results revealed that instillation of 100 % carbolic acid with BFS to treat BPF was 100 % effective, which can be a support for post-pulmonectomy BPF
Summary
Bronchopleural fistula (BPF) is a relatively infrequent but potentially fatal complication of pulmonary resection. It is estimated that incidence of BPF after pneumonectomy and lobectomy for lung cancer is 4.5–20 % and 0.5 %, respectively, and the incidence of BPF is highest after right pulmonary resection and right lower lobectomy [31]. Amplatzer vascular plug, which was originally designed for the transcatheter closure of vascular structures, has been reported as a safe and effective method to treat small postoperative BPF [9]. Fruchter et al found that the technique of Amplatzer double-disk occluder implantation may be suitable for both large and small BPFs which originate from the main bronchi and lobar bronchi, respectively [8]. Endoscopic approaches and bronchoscopy are common methods of treating BPF to avoid thoracotomy [27, 36]
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