房间隔封堵器封堵支气管胸膜瘘1例报告[摘要]支?夤苄啬ゐ?是肺切除术后罕见但最严重的并发症之一，病死率高。有效的治疗方法对支气管胸膜瘘的预后有重要意义。目前对于支气管胸膜瘘的治疗尚无相关指南和标准，为评估房间隔封堵器封堵全肺切除术后早期支气管胸膜瘘（BPF）的临床疗效，本文回顾性分析2016年12月云南省肿瘤医院胸外一科诊治的1例临床诊断为左全肺切除术后支气管胸膜瘘患者的临床资料。该患者临床表现为咳嗽，咳痰，伴痰中带血，复查胸部CT和电子支气管镜，发现左肺支气管胸膜瘘。根据支气管胸膜瘘的解剖特点和病变特征，采用房间隔封堵器封堵瘘口。第1次置入房间隔封堵器（6mm）时，一次置入成功，房间隔封堵器置入后左肺支气管瘘口完全封堵。5d后做电子支气管镜检查，评估肺部和气道情况，发现左肺支气管残端封堵器移位。再次置入房间隔封堵器（18mm），一次置入成功，瘘口完全封堵。封堵器置入3个月后患者左侧胸膜残腔完全消失，瘘口愈合，肺功能明显改善。应用房间隔封堵器对肺叶切除术后形成的早期支气管胸膜瘘进行封堵，操作简单，加快瘘口愈合，残腔消失。改善患者的生活质量，临床效果良好。通过临床资料分析，房间隔封堵器封堵支气管胸膜瘘是一种科学有效、瘘口愈合快、手术安全性好、操作简便、术后并发症少的治疗新方法，可推广应用。[关键词]肺切除术；支气管胸膜瘘；房间隔封堵器；电子支气管镜[]R541.1[文献标识码]A[]1674-4721（2018）2（c）-0145-03[Abstract]Bronchopleuralfistulaisoneofthemostrarebutseriouscomplicationsafterpneumonectomy，withhighmortality.Effectivetreatmentisofgreatsignificancetotheprognosisofbronchopleuralfistula.Atpresent，therearenorelevantguidelinesandstandardsforthetreatmentofbronchopleuralfistula.Inordertoevaluatetheclinicalefficacyofatrialseptaloccluderforearlybronchopleuralfistula（BPF）aftertotalpneumonectomy，thispaperretrospectivelyanalyzedtheclinicaldataofonecasediagnosedasbronchopleuralfistulaaftertotalpneumonectomyinYunnancancerhospitalinDecember2016.Theclinicalmanifestationsofthispatientarecough，expectoration，accompaniedbybloodinsputum，didchestCTandelectronicbronchoscopy，thenfoundleftpulmonarybronchopleuralfistula.Accordingtotheanatomicalcharacteristicsandpathologicalfeaturesofbronchopleuralfistula，theatrialseptaloccluderwasusedtooccludethefistula.Thefirstplacementoftheatrialseptaloccluder（6mm）wassuccessful，andtheleftpulmonarybronchialfistulawascompletelyoccludedafterplacementoftheatrialseptaloccluder.Fivedayslater，anelectronicbronchoscopywasperformedtoassessthepulmonaryandairwayconditionsandfoundthattheleftpulmonarybronchialstumpoccluderwasdisplaced.Toplacetheatrialseptaloccluder（18mm）again，onceplacedsuccessfully，andthefistulawascompletelyoccluded.Theleftpleuralresidualcavitydisappearedcompletelyaftertheoccluderwasplacedfor3months，thefistulahealedandthepulmonaryfunctionimprovedobviously.Theatrialseptaloccluderwasusedtooccludetheearlybronchopleuralfistulaafterlobectomy.Theoperationwassimple，thefistulahealingwasacceleratedandtheresidualcavitydisappeared.Aswellasimprovethequalityoflifeofpatients，theclinicaleffectisgood.Alargenumberofclinicaldatashowsthattheatrialseptaloccluderisascientificandeffectivemethodwhichowestheadvantagesofthetreatmentofbronchopleuralfistula，rapidhealingoffistula，goodsurgicalsafety，simpleandconvenientoperationandlesspostoperativecomplications.Itcanbepopularizedandapplied.[Keywords]Pneumonectomy；Bronchopleuralfistula；Atrialseptaldefectoccluder；Electronicbronchoscope支气管胸膜瘘（bronchopleuralfistula，BPF）是指支气管残端与胸膜腔形成的瘘道，据相关文献统计，支气管胸膜瘘的发生...