支气管内引流管治疗术后瘘、难治性气胸和咯血的有效性和安全性：一项单中心回顾性研究

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2025-07-02 DOI:10.1016/j.resinv.2025.06.016

Miwa Kamatani, Nobuyasu Awano, Minoru Inomata, Keita Sakamoto, Haruka Fujioka, Takehiro Izumo

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引用次数: 0

摘要

背景支气管胸膜瘘、难治性气胸和大咯血是临床面临的重大挑战。支气管内插管为这些疾病的治疗提供了一种侵入性较小的手术干预方法。本研究旨在评价支气管胸膜瘘、难治性气胸和咯血患者行支气管内引流术的有效性和安全性，这些患者的介入放疗或手术治疗都是不可行的。方法回顾性分析2017年12月至2024年1月在日本红十字会医疗中心进行的支气管插管手术。分析包括患者人口统计学、手术细节、目标支气管识别方法、额外治疗、临床结果和并发症。结果20例患者共行27道手术，其中顽固性气胸16例，术后瘘2例，咯血2例。通过球囊闭塞、在透视引导下支气管内注射造影剂和经胸管胸腔内注射靛蓝胭脂红来确定支气管。在20例患者中，15例（75%）获得临床改善：术后瘘1/2(50%)，难治性气胸12/16(75%)，咯血2/2（100%）。手术相关的并发症，如支气管内引流管移位（3例）和纵隔和腹腔内肺气肿（1例），通过保守治疗得到解决。结论支气管内插管治疗难治性气胸、术后瘘、咯血是一种有价值的治疗方法。

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Efficacy and safety of endobronchial spigot for the management of postoperative fistula, refractory pneumothorax, and hemoptysis: A single-center retrospective study

Background

Bronchopleural fistula, refractory pneumothorax, and massive hemoptysis pose significant clinical challenges. Endobronchial spigot offers a less invasive alternative to surgical interventions for the management of these conditions. This study aimed to evaluate the efficacy and safety of endobronchial spigot in patients with bronchopleural fistula, refractory pneumothorax, and hemoptysis in whom interventional radiology or surgical intervention was not feasible.

Methods

Endobronchial spigot procedures performed at the Japanese Red Cross Medical Center between December 2017 and January 2024 were retrospectively analyzed. Patient demographics, procedural details, methods of target bronchus identification, additional treatments, clinical outcomes, and complications were included in the analysis.

Results

A total of 27 procedures were performed in 20 patients, including 16 patients with intractable pneumothorax, 2 with postoperative fistula, and 2 with hemoptysis. The responsible bronchi were identified using balloon occlusion, endobronchial injection of a contrast medium under fluoroscopic guidance, and intrathoracic injection of indigo carmine via thoracic tubes. Of the 20 patients, 15 (75 %) achieved clinical improvements: postoperative fistula 1/2 (50 %), refractory pneumothorax 12/16 (75 %), and hemoptysis 2/2 (100 %). Procedure-related complications, such as endobronchial spigot migration (3 patients) and mediastinal and intra-abdominal emphysema (1 patient), were resolved with conservative managements.