Reconstructive surgery for bronchial fistulas after resections of the lung

Abstract

From 2000 to 2019, 22 patients who had previously undergone various resections for purulent-destructive lung diseases complicated by fistulas of the bronchial stump underwent reconstructive operations. Men -15(68,2%), women -7(31,2%). Right-sided lesion was observed in 13 patients, left-sided - in 9. All empyemas were postoperative: after lobectomy-5, after atypical resection-2, after pneumonectomy-15. Bronchopleurothoracic fistula was diagnosed in 10 patients, bronchopleural fistula - 11, esophageal-pleuro-bronchial fistula in 1 patient. 22 patients underwent 25 operations: resection of the remaining part of the lung by type pneumonectomy – 3, transpleural reresection of the main bronchus stump – 6 (in combination with 4-rib thoracoplasty – 2, with pleurectomy – 4), transpleural intrapericardial occlusion of main bronchus – 2, transsternal occlusion of main bronchus – 10 (in 2 cases with thymectomy), reresection of lobar bronchus stump – 3 (4-rib thoracoplasties – 1), 7-rib thoracoplasty – 1. Postoperative complications were observed in 11 patients (50.0%). Relapse of pleural empyema -9, suppuration of the wound-4, insufficiency of bronchial stump -4, pleurothoracal fistula-1. Operational lethality – 1 (4%) patient. Intraoperatively, profuse bleeding occurred from the pulmonary artery, which was located in the inflammatory conglomerate of the lung hilus, the defect of the artery wall was restored by an atraumatic suture, but due to the instability of hemodynamics, the patient developed bradycardia with a transition to asystole.

Early diagnosis of bronchial fistula and an adequate choice of the method of its elimination are the key to effective treatment of this heavy contingent of patients.