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Wang L, Chen F, He Z, He X, Zhang C. Salvage treatment of acute respiratory failure after autogenous tissue flap transplantation for chronic empyema with chest wall sinus: a case report and literature review. J Cardiothorac Surg 2024; 19:32. [PMID: 38291447 PMCID: PMC10829253 DOI: 10.1186/s13019-024-02488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Chronic empyema with chest wall sinus is a difficult and complex disease caused by multiple causative factors. It is difficult to control local infection due to its possible combination of bronchopleural fistula (BPF) and residual bone.The relevant literature emphasizes some risk factors for empyema progression after pneumonectomy, while the correlation between empyema and BPF after pneumonectomy increases mortality by infecting the remaining lungs. After pneumonectomy, the lung function of the contralateral side is particularly important. CASE PRESENTATION This paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 12 years ago and began to develop empyema with anterior chest wall sinus 3 years ago. After admission, chest computed tomography (CT) showed right pleural effusion and formation of chest wall sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the huge residual cavity of the patient,the clinical effect of using free vastus lateralis myocutaneous flap combined with pedicled pectoralis major muscle flap to fill the abscess cavity was satisfactory,but acute respiratory failure occurred due to left lung aspiration pneumonia after operation. CONCLUSIONS After a series of treatment measures such as tracheal cannula, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, the patient was ultimately rescued and cured. Postoperative follow-up showed that the muscle flaps survived and empyema was eliminated.
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Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd, Hangzhou, China
| | - Fei Chen
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd, Hangzhou, China.
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd, Hangzhou, China
| | - Xueming He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Rd, Hangzhou, China
| | - Chun Zhang
- Department of Traumatology and Orthopedic Surgery, Tongde Hospital of Zhejiang Province, 310012, Hangzhou, Zhejiang, China
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Clark JM, Cooke DT, Brown LM. Management of Complications After Lung Resection: Prolonged Air Leak and Bronchopleural Fistula. Thorac Surg Clin 2020; 30:347-358. [PMID: 32593367 PMCID: PMC10846534 DOI: 10.1016/j.thorsurg.2020.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/JamesClarkMD
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/DavidCookeMD
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA.
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Guo X, Wang H, Wei Y. [Pneumonectomy for Non-small Cell Lung Cancer: Predictors of Operative Mortality and Survival]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:573-581. [PMID: 32702791 PMCID: PMC7406439 DOI: 10.3779/j.issn.1009-3419.2020.101.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
外科手术是目前根治非小细胞肺癌(non-small cell lung cancer, NSCLC)的最有效方式。全肺切除作为一种术式被应用于临床中。对于中央型肺癌,袖式肺叶切除术因其术后肺功能丧失少、术后并发症及死亡率低逐渐取代全肺切除术成为主流。然而为保证肿瘤学效果,当其他术式无法完全切除时,全肺切除术式仍是必要的。全肺切除术后主要发生心肺并发症,充分了解全肺切除术后相关并发症能帮助临床医师及时做出诊断,并进一步采取相关措施降低术后并发症对患者的不良影响。充分了解预后相关危险因素可帮助临床医师提前采取措施尽可能规避风险,从而改善患者预后。
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Affiliation(s)
- Xiaokang Guo
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Huafeng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Yucheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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Hicham H, Ibrahim I, Rabiou S, Marouane L, Yassine O, Mohamed S. Postpneumonectomy empyema: risk factors, prevention, diagnosis, and management. Asian Cardiovasc Thorac Ann 2019; 28:89-96. [PMID: 31865750 DOI: 10.1177/0218492319888048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Postpneumonectomy empyema is a collection of pus in the pleural space after removal of the underlying lung. Postpneumonectomy empyema is a serious complication responsible for high rates of morbidity and mortality. Several risk factors for the development of postpneumonectomy empyema have been highlighted in the literature. The association of postpneumonectomy empyema with a bronchopleural fistula increases the rate of mortality by flooding the remaining lung. The management of postpneumonectomy empyema depends on the timing of presentation and the presence or absence of a bronchopleural fistula. The goals of care in the acute period are mainly preservation of the contralateral lung and sterilization of the pleural space, which may take a considerable time. The aims in the late period are closure of the bronchopleural fistula, obliteration of the pleural space, and closure of the chest wall.
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Affiliation(s)
| | | | - Sani Rabiou
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
| | - Lakranbi Marouane
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Ouadnouni Yassine
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Smahi Mohamed
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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Gritsiuta AY, Eguchi T, Jones DR, Rocco G. A Stepwise Approach for Postlobectomy Bronchopleural Fistula. ACTA ACUST UNITED AC 2019; 25:85-104. [PMID: 34177378 DOI: 10.1053/j.optechstcvs.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although rare, bronchopleural fistula (BPF) following anatomic lung resection is a serious complication associated with high rates of mortality (25%-71%). Risk factors for BPF include surgical approach, neoadjuvant therapy, diabetes mellitus, and chronic obstructive pulmonary disease. As neoadjuvant treatment is increasingly being administered to patients with locally advanced lung cancer, and as more patients are being diagnosed with lung cancer at an older age-elderly patients present with a higher index of multiple comorbidities-the incidence of BPF among patients undergoing anatomic resection for lung cancer is expected to increase. In this manuscript, we detail risk factors and considerations for BPF and describe a stepwise approach to treat BPF following lobectomy for lung cancer.
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Affiliation(s)
- Andrei Y Gritsiuta
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
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Petrella F, Sandri A, Rizzo S, Borri A, Galetta D, Gasparri R, Spaggiari L. Emergency drain for post pneumonectomy bronchopleural fistula: a drain placement technique based on the siphon principle. J Thorac Dis 2018; 10:468-471. [PMID: 29600080 DOI: 10.21037/jtd.2017.11.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Post pneumonectomy bronchopleural fistula (BPF) is a life-threatening complication requiring pleural cavity drainage to avoid acute mediastinal shift and contralateral aspiration pneumonia. Chest drain insertion in this situation may be technically difficult because of drastic anatomical changes such as mediastinal dislocation, diaphragm elevation and, sometimes, massive subcutaneous emphysema. In addition, the most important part of the pleural cavity to be drained is the costophrenic recess that is scarcely drained by a standard chest tube with its tip aiming high and upwards. We propose a safe, simple and effective technique based on the siphon principle to drain the lowest part of the pleural cavity.
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Affiliation(s)
- Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Alberto Sandri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Stefania Rizzo
- Division of Radiology, European Institute of Oncology, Milan, Italy
| | - Alessandro Borri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
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7
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Anesthesia for Pleural and Chest Wall Surgery. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Empyema after anatomic lung resection is rare but causes serious morbidity, particularly if associated with a bronchopleural fistula. Careful assessment of preoperative risk factors and proper surgical technique can minimize risks. Empyema after segmentectomy or lobectomy may respond to simple drainage and antibiotics, or may require decortication with or without muscle transposition. After pneumonectomy, treatment principles include initial drainage of the intrathoracic space, closure of the fistula if present, and creation of an open thoracostomy, which is packed and later closed. Success rates can exceed 80%.
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Affiliation(s)
- Giorgio Zanotti
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Academic Office 1, Room 6602, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA
| | - John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Academic Office 1, Room 6602, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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Analysis of the surgical treatment of endobronchial tuberculosis (EBTB). Surg Today 2014; 44:1434-7. [PMID: 24733112 DOI: 10.1007/s00595-014-0865-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/18/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree. EBTB may require aggressive treatment, including lung resection, because of severe bronchostenosis and its complications, despite formal anti-TB chemotherapy. We present our experience of treating 25 patients with EBTB. METHODS We reviewed retrospectively the medical records of 25 patients with EBTB treated between 2002 and 2012 at the Department of Thoracic Surgery in Beijing Chest Hospital. RESULTS All 25 patients (5 male, 20 female) underwent surgery for fibrostenotic type EBTB. Bronchoscopy showed fibrostenotic change in all patients and a cough was the most common symptom. Postoperatively, all patients were given anti-TB therapy to take for 6-9 months. CONCLUSIONS EBTB tends to occur at a higher incidence in young women. Surgery may be required for severe bronchostenosis and its complications and should be performed for symptomatic fibrostenotic type EBTB. During the operation, attention should be paid to prevent severe complications and postoperative anti-TB therapy is mandatory.
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Belcher E, Dusmet M, Jordan S, Ladas G, Lim E, Goldstraw P. A prospective, randomized trial comparing BioGlue and Vivostat for the control of alveolar air leak. J Thorac Cardiovasc Surg 2010; 140:32-8. [PMID: 20620377 DOI: 10.1016/j.jtcvs.2009.11.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/21/2009] [Accepted: 11/14/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE BioGlue (CryoLife, Europa Ltd, Surrey, UK) is effective in reducing alveolar air leak after pulmonary resection. However, concerns exist regarding the use of bovine-derived products. Vivostat (Vivostat A/S, Alleroed, Denmark) is an autologous fibrin sealant that confers certain advantages. It shows superior elastic properties, a faster absorption time, and the absence of risk of transmission of blood-borne diseases. METHODS We conducted a randomized, single blind controlled study to compare BioGlue and Vivostat in the control of postoperative air leak. Primary endpoints were duration of air leak, time to intercostal drain removal, and length of hospital stay. Secondary endpoints related to postoperative complications. RESULTS Between December 2005 and December 2007, 103 patients were randomized. The analysis included 102 patients; 67% were male. Median age was 56 +/- 19 years. Indications for surgery were primary lung cancer in 41 patients (40%), secondary malignancy in 48 patients (47%), carcinoid in 6 patients (6%), and 7 patients underwent surgery for benign disease (7%). Bilobectomy was performed in 2 patients (2%), lobectomy in 41 patients (40%), lobectomy with lesser resection in 3 patients (3%), segmentectomy in 16 patients (16%), precision excision in 34 patients (33%), and 6 patients underwent other resections (6%). Median duration of air leak was 3 (0-32) days versus 2 (0-33) days for patients who received BioGlue and Vivostat, respectively (P = .677). Time to intercostal drain removal was 5 (1-32) days in the BioGlue group compared with 5 (1-34) days for the Vivostat group (P = .473). Median hospital stay was 8 (3-22) days versus 7 (2-29) days for the BioGlue and Vivostat groups, respectively (P = .382). There was no significant difference in the incidence of complications between the 2 groups (20 patients receiving BioGlue versus 19 patients receiving Vivostat, P = .839). CONCLUSIONS There were no significant differences in the 3 clinical outcome measures of duration of air leak, time to intercostal drain removal, and length of hospital stay in those patients receiving BioGlue or Vivostat. Given the inherent advantages of our institutional preference is to use Vivostat in the control of postoperative air leaks after pulmonary resection.
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Affiliation(s)
- Elizabeth Belcher
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
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Ng T, Ryder BA, Maziak DE, Shamji FM. Treatment of Postpneumonectomy Empyema with Debridement Followed by Continuous Antibiotic Irrigation. J Am Coll Surg 2008; 206:1178-83. [DOI: 10.1016/j.jamcollsurg.2008.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 12/08/2007] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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Varker KA, Ng T. Management of empyema cavity with the vacuum-assisted closure device. Ann Thorac Surg 2006; 81:723-5. [PMID: 16427885 DOI: 10.1016/j.athoracsur.2004.10.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Revised: 09/21/2004] [Accepted: 10/08/2004] [Indexed: 11/30/2022]
Abstract
Management of empyema after pulmonary resection remains a challenging problem. Along with mandatory drainage of the thoracic cavity and investigations to rule out bronchopleural fistula, a reliable method of thoracic cavity closure is needed. The open thoracic window and Eloesser flap techniques rarely represent definitive therapy. Muscle flap and thoracoplasty procedures may provide well-vascularized tissue to close bronchopleural fistula and obliterate the empyema cavity, but they are quite complex and involve significant patient morbidity. We report a case of empyema without bronchopleural fistula after lobectomy in which the vacuum-assisted closure device was used to achieve complete wound healing after open drainage.
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Affiliation(s)
- Kimberly A Varker
- Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA.
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Gharagozloo F, Margolis M, Facktor M, Tempesta B, Najam F. Postpneumonectomy and Postlobectomy Empyema. Thorac Surg Clin 2006; 16:215-22. [PMID: 17004549 DOI: 10.1016/j.thorsurg.2006.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although similar strategies are used in the management of PPE and PLE, these conditions need to be viewed as two separate entities. For the purpose of devising the appropriate management strategy, PPE should be divided into early and late, with and without mediastinal induration and extensive pleural space contamination. If at all possible, PLE should be managed as a postpneumonic empyema with prolonged chest tube drainage. The key to these conditions is prevention.
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Affiliation(s)
- Farid Gharagozloo
- Washington Institute of Thoracic and Cardiovascular Surgery, The George Washington University Medical Center, 2175 K Street NW, Washington, DC 20037, USA.
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