Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Bronchopleural Fistula after Pneumonectomy: Autosuture Versus Manual Suture

전폐절제술 시 기관지 절단부에서 자동봉합기의 사용과 수기 봉합술의 흉강-기관지루 발생 비교

  • Lim, Hyoun-Soo (Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Kang, Jung-Ho ( Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Chung, Won-Sang ( Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Kim, Young-Hak ( Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Kim, Hyuck ( Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Lee, Chul-Bum ( Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University) ;
  • Jee, Heng-Ok ( Dept. of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University)
  • 임현수 (한양대학교 의과대학 흉부외과학교실) ;
  • 강정호 (한양대학교 의과대학 흉부외과학교실) ;
  • 정원상 (한양대학교 의과대학 흉부외과학교실) ;
  • 김영학 (한양대학교 의과대학 흉부외과학교실) ;
  • 김혁 (한양대학교 의과대학 흉부외과학교실) ;
  • 이철범 (한양대학교 의과대학 흉부외과학교실) ;
  • 지행옥 (한양대학교 의과대학 흉부외과학교실)
  • Published : 2003.09.01
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Abstract

Staple closure of bronchial stump was compared with manual suture closure among 100 cases of pneumonectomy during the recent 5-year period, We have reviewed the incidence of bronchpleural fistula between autosutured group and manual sutured group. Material and Method: During the recent 5-year period, 100 patients underwent pneumonectomy at Hanyang University Hospital. Staple closure of bronchial stump was performed in 65 patients and manual suture in 35 patients. There were 55 males and 10 females in the autosutured group, and 26 males and 9 females in manual sutured group, which showed no significant statistical difference between the two groups. The mean ages of patients for autosutured group and manual sutured group were 56.7$\pm$10.3 years and 61.4$\pm$9.2 years, respectively, which showed no significant statistical difference between the two groups. There were 38 cases of left pneumonectomy and 27 cases of right pneumonectomy in autosutured group, and 22 cases of left pneumonectomy and 13 cases of right pneumonectomy in manual sutured group. There were 53 cases of malignancy and 12 cases of benign imflammatory disease in autosutured group, and 27 cases of malignancy and 7 cases of benign imflammatory disease in manual sutured group. Result: The incidence of bronchopleural fistula was 6.1％ in autosutured group and 5.7％ in manual sutured group. The incidence of other postoperative complication between the two groups showed no significant statistical difference. Conclusion: The incidence of bronchopleural fistula between autosutured group and manual sutured group was not different stastically. Both method for closure of bronchial stump can be performed in pneumonectomy.

본원에서 시행한 최근 5년간 전폐절제술 중 기관지 절단부의 처리 방법에 있어 수기봉합 35예, 자동봉합 65예를 선정하여 술 후 합병증의 발생을 중점으로 비교 분석하였다. 대상 및 방법: 자동봉합기를 사용한 65예 중 남성은 55명, 여성은 10명이었으며 평균 연령은 56.7$\pm$10.3세였다. 수기봉합을 시행한 35예 중 남성은 26명, 여성은 9명으로 평균연령은 61.4$\pm$9.2세)였다. 자동봉합기를 사용한 수술예 중 38예가 좌주기관지에, 27예가 우주기관지 봉합 예였으며, 수기 봉합의 경우 좌주기관지 22예, 우주기관지 13예였다. 자동봉합기를 사용한 65예 중 편평세포암이 39예, 선암종이 9예, 기타 악성 폐암 5예, 양성 페질환이 12예였으며, 수기봉합을 시행한 35예 중 편평세포암이 21예, 선암종이 5예, 기타 악성폐암 2예, 양성 폐질환이 7예였다. 결과: 술 후 합병증으로 자동봉합기를 사용한 65예 중 4예의 기관지-흉막루가 발생하였고 2예에서 폐부종이 발생하여 호흡부전으로 사망하였다. 또한 2예는 술 후 급성 호흡부전으로 사망하였다 수기 봉합의 35예 중 기관지-흉막루가 2예 발생하여 그중 1예에서 농흉이 동반되어 폐혈증으로 사망하였으며, 2예는 술 후 급성 호흡부전으로, 1예는 폐렴 후 폐혈증으로 사망하였다. 결론: 수기 봉합과 자동 봉합기의 사용 예를 비교하여 술 후 합병증의 빈도는 통계학적 유의성을 보이지 않았으며, 술자의 선택에 따라 두 방법 모두 가능한 방법이라 하겠다

Keywords

References

  1. J Thorac Cardiovasc Surg v.62 Management of persistent bronchopleural fistula Baker WL.;Faber LP.;Ostermiller WE. Jr.;Langston HT.
  2. Tuberkulozis v.12 Tudoresectio bronchus es ervarrogeppel Amosov NM.
  3. J Thorac Cardiovasc Surg v.41 Pulmonary resection with mechanical suture Amosov NM.;Berezovsky KK.
  4. Surgery v.46 Experimental and clinical use of the Soviet bronchus stapling instrument Ravitch MM.;Brown IW.;Daviglus GF.
  5. J Thorac Cardiovasc Surg v.47 Clinical experiences with the Soviet mechanical bronchus stapler (UKB-25) Ravitch MM.;Steichen FM.;Fishbein RH.;Knowles PW.;Weil P.
  6. JAMA v.101 Successful removal of an entirelung for carcinoma of the bronchus Graham EA.;Singer JJ. https://doi.org/10.1001/jama.1933.02740430017005
  7. Bull Johns Hopkins Hosp v.53 Pneumonectomy: a preliminary report of the operative technique in two swccessful cases Rienhoff WF.
  8. Surg Gynecol Obstet v.116 Results of the surgical treatment of bronchogenic carcinoma Sensening DM.;Rossi NP.;Ehrenhaft JL.
  9. Med Klin v.60 Ergebnisse der chirurgischen Behanndlung beim Bronchus Karzinom Buchenberger R.;Jenny RH.
  10. Surg Gynecol Obstet v.109 Complications in 430 consecutive pulmonary resections for tuberculosis Floyd RD.;Hollister WF.;Dealy WC.
  11. Chest v.92 Bronchopeural fistulas after pneumonectomy.A problem with surgical stapling Smiell J.;Widmann WD. https://doi.org/10.1378/chest.92.6.1056
  12. Scand J Cardiovasc Surg v.26 Suture closure versus stapling of bronchial stump in 304 lung cancer operations Weissberg D.;Kaufman M. https://doi.org/10.3109/14017439209099066
  13. Ann Surg v.184 Bronchial stump closure technique following pneumonectomy: a serial comparative study Scott RN.;Faraci RP.;Hough A.;Chretine PB. https://doi.org/10.1097/00000658-197608000-00012
  14. Ann Thorac Surg v.52 Bronchopleural fistula after stapled closure of bronchus Vester SR.;Faber LP.;Kittle CF.;Warren WH.;Jensik RJ. https://doi.org/10.1016/0003-4975(91)90009-F