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The Journal of Thoracic and Cardiovascular Surgery, Vol 76, 755-762, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JR Hankins, JE Miller, S Attar, JR Satterfield and JS McLaughlin
Bronchopleural fistula, although reduced in incidence in recent years,
remains a grave complication of pulmonary disease and of pulmonary
resection. In a series of 77 patients treated for bronchopleural fistula
over a 13 year period, 49 of whom had postresection fistulas, only 44 (57.1
percent) were cured of the fistula and 15 (19.5 percent) died. Prevention
assumes great importance. Key factors in prevention are avoidance of
pulmonary resection in tuberculous patients with positive sputum;
overzealous dissection of the bronchus; a long bronchial stump; tumor in
the bronchial stump; contamination of the pleural cavity; and too little
tissue left behind to fill the pleural space. Treatment should be surgical.
In none of the six patients treated conservatively was the fistula
obliterated. Seventy-one patients were treated surgically, and 133
operations were needed to effect fistula obliteration in the 44 patients
(62 percent) in whom this was achieved. Adequate surgical drainage has
always been the sine qua non of effective treatment, and yet this alone
brought about closure of the fistula in only nine patients. Early resuture
of the bronchial stump succeeded in only two of five patients.
Thoracoplasty combined with drainage effected closure in seven of 11
patients. The highest rate of fistula closure with the lowest mortality
occurred among the 20 patients who underwent myoplasty, usually combined
with a limited thoracoplasty. In this group, the fistula was obliterated in
16 patients, with one death.
ARTICLES
Bronchopleural fistula. Thirteen-year experience with 77 cases
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