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目的探讨全肺切除术后早期支气管胸膜瘘的诊断方法。方法 1 046例原发性肺癌行全肺切除术后30 d内共发生支气管胸膜瘘30例,分析其临床和病理资料,尤其关注瘘发生前后胸部X线平片和支气管镜下所见。结果支气管胸膜瘘发生在术后2周内20例,其中术后3~10 d发生15例。临床表现为气短13例、痰量增加13例、刺激性咳嗽13例、发热9例、皮下气肿9例。胸部X线平片表现为未经引流或胸穿而胸液平面下降1 cm以上10例。纤维支气管镜检查窥及支气管瘘口23例、残端气泡6例、残端溃疡3例。结论全肺切除术后支气管胸膜瘘主要发生于术后2周内。早期支气管胸膜瘘最常见的症状为气短、咳嗽、痰量增加,胸部X线平片最常见的征象为胸液平面下降1 cm以上。X线胸片和纤维支气管镜检查是最简单有效的诊断方法 。
Objective To investigate the diagnosis of early bronchopleural fistula after pneumonectomy. Methods Thirty bronchial pleural fistulas were performed in 30 cases of pneumonitis in 1 046 patients with primary lung cancer. The clinical and pathological data were analyzed. The chest X-ray plain film and bronchoscopy were observed before and after the onset of fistula. Results Bronchial pleural fistula occurred in 20 cases within 2 weeks after operation, and 15 cases occurred 3 to 10 days after operation. The clinical manifestations included shortness of breath in 13 cases, sputum volume in 13 cases, irritation in cough in 13 cases, fever in 9 cases, and subcutaneous emphysema in 9 cases. Chest X-ray plain film showed no drainage or thoracentesis and the pleural fluid level dropped by more than 1 cm in 10 cases. Fiberoptic bronchoscopy revealed 23 cases of bronchial fistula, 6 cases of stump air bubble, and 3 cases of stump ulcer. Conclusion Bronchial pleural fistulas occur after pneumonectomy mainly within 2 weeks after operation. The most common symptoms of early bronchopleural fistulas are shortness of breath, cough, and increased sputum. The most common signs of chest radiographs are a decrease of more than 1 cm in the pleural fluid level. X-ray and fiberoptic bronchoscopy are the simplest and most effective diagnostic methods.