Postoperative Ischemic Bronchitis After Lymph Node Dissection and Primary Lung Cancer Resection
Postoperative Ischemic Bronchitis After Lymph Node Dissection and Primary Lung Cancer Resection
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DOI：
10.1016/j.athoracsur.2010.09.021
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发表时间：
2011-02-01
影响因子：
4.6
通讯作者：
Porte, Henri
中科院分区：
文献类型：
--
作者：
Benhamed, Lotfi;Bellier, Jocelyn;Porte, Henri
背景资料。目的了解系统淋巴清扫术(LND)术后缺血性支气管炎(POIB)的发生率和症状，评价高压氧治疗肺癌的疗效。从2004年1月到2009年12月，1071名患者接受了非小细胞肺癌的标准切除和根治性系统性淋巴清扫术。术后7~12天进行系统的纤维支气管镜检查，分析POIB的临床和生物学征象。一旦诊断确定高压氧治疗，就进行治疗。34例(3.21%)患者存在POIB，其中女性2例，男性32例。平均年龄59岁+/-10岁(25~79岁)。POIB发生在8+/-3d内，右肺切除后21例(62%)，左肺切除后13例(38%)。27例(80%)患者出现无症状的POIB，而只有7例(20%)患者出现发热和高白细胞。病变部位：支气管残端21例(62%)，同侧支气管树11例(32%)，向对侧支气管树延伸2例(6%)。高压氧治疗的平均次数为14次(1至48次)。有6名患者(18%)的POIB恶化，需要手术抢救。POIB的临床表现很差，应该进行系统的纤维支气管镜检查，特别是在有高风险的支气管胸膜瘘的患者。高压氧治疗缺血性支气管炎可能是一种有前途的辅助治疗方法。(Ann Thorac Surg 2011；91：355-60)(C)2011年，胸外科学会
Background. The purpose of this study was to determine the incidence and symptoms of postoperative ischemic bronchitis (POIB) after systematic lymph node dissection (LND) and evaluate the effect of hyperbaric oxygen therapy in patients with primary lung cancer.Methods. From January 2004 to December 2009, 1,071 patients underwent a standard resection for non-small cell lung cancer and radical systematic lymph node dissection. Fiberoptic bronchoscopy was performed systematically between days 7 and 12. We analyzed the clinical and biologic signs of POIB. Once the diagnosis established a treatment by hyperbaric oxygen, therapy was undertaken.Results. A POIB was observed in 34 patients (3.21%) (2 women and 32 men). Mean age was 59 +/- 10 years (range, 25 to 79 years). A POIB occurred within 8 +/- 3 days; after right pulmonary resection (n = 21; 62%) and after left resection (n = 13; 38%). A POIB appeared asymptomatically for 27 patients (80%), whereas only 7 patients (20%) presented with fever and hyperleukocytosis. Their localization were bronchial stumps (n = 21; 62%), homolateral bronchial tree (n = 11; 32%), or extension toward the contralateral bronchial tree (n = 2; 6%). The mean number of hyperbaric oxygen therapy sessions was 14 (1 to 48). A POIB worsening was observed in 6 patients (18%), requiring a surgical rescue therapy.Conclusions. The clinical presentation of POIB is poor and systematic fiberoptic bronchoscopy should be performed, especially in patients with a high risk of bronchopleural fistula. Hyperbaric oxygen therapy in the management of ischemic bronchitis may be a promising adjunctive treatment. (Ann Thorac Surg 2011; 91: 355-60) (C) 2011 by The Society of Thoracic Surgeons