TREATMENT OF BRONCHOPLEURAL FISTULAS

Abstract

Summary. The article is due to consideration of the etiology, diagnosis and treatment of patients with bronchopleural fistula. Bronchopleural fistula (BPF) most often occurs after surgery for lung resection (pneumonectomy, lobectomy, segmentectomy), with a frequency of 1.5 to 4.5 % after pneumonectomy and 0.5 to 1 % after lobectomy. The development of BPF can be influenced by the technique of closing the bronchi (manual or mechanical suture). Other etiologic factors include complications of malignancy treatment, including chemotherapy, radiation therapy, and chest trauma. Most patients develop BPF in the first two weeks (<14 days) after lung resection, but the exact proportion is unknown. BPF can be assumed in a patient with lung resection. The diagnosis of BPF is made using a combination of clinical, X-ray, and bronchoscopic findings that confirm air leakage from the main, lobe, or segmental bronchus into the pleural cavity. There are no specific laboratory findings, although some patients with an infected pleural space (due to BPF) may have leukocytosis or elevated C-reactive protein. The presence of a fistula is often visible on an X-ray of the chest organs, and is more effectively evaluated on a chest computed tomography (CT). BPFs do not close spontaneously and almost always require any surgical or bronchoscopic intervention, so all patients require a multidisciplinary discussion. Since most BPFs occur early in the postoperative period and do not become infected, most patients undergo surgical treatment with a satisfactory outcome. Bronchoscopic techniques have variable success rates and are applicable to patients in whom surgery is contraindicated, including patients with septic shock and severe hypoxemia, as well as patients on mechanical ventilation, patients in whom surgery is risky, and patients for whom it is stage before surgery. So, bronchopleural fistula (BPF) is a connection between the main trunk, a segmental or segmental bronchus and the pleural space. Patients with BPF may have symptoms that range from acute symptoms of tension pneumothorax (eg, shortness of breath, chest pain, tracheal deviation to the contralateral side) to subacute symptoms of empyema (eg, fever, cough with copious amounts of purulent sputum), persistent air defecation through pleural drainage. All patients with BPF require an interdisciplinary approach. For patients who have failed surgery or bronchoscopy, options include reoperation, an alternative bronchoscopic approach, or, in some cases, thoracostomy. BPF is associated with significant morbidity and mortality, ranging from 21 to 71 %, especially in the setting of post-pneumonectomy empyema. The best results of the treatment of patients were obtained with demonstrated aggressive surgical professionalism.