Clinical study on prevention of bronchopleural fistula after lobectomy in high-risk patients with improved pedicled pre-pericardial fat pad
Objective To explore the clinical effect of modified pedicled pericardial fat pad in preventing bron-chopleural fistula after lobectomy in high-risk patients,and to provide a feasible method and basis for the preven-tion of bronchopleural fistula.Methods In this study,the clinical data of patients with high risk of bronchopleu-ral fistula who underwent lobectomy in thoracic surgery in our hospital from January 2017 to March 2019 were collected.This group was the control group without special treatment of bronchial stump during operation.At the same time,the clinical data of patients who underwent lobectomy from March 2019 to November 2021 with high risk of bronchopleural fistula were also collected.This group was the experimental group,and patients underwent modified pedicled pre-pericardial fat pad to embed bronchial stump during operation.The above two groups were matched with 1∶1 propensity score.Follow-up after operation was achieved,and the differences in bronchopleu-ral fistula incidence and occurrence time,mortality,operation time,intraoperative bleeding,postoperative cathe-terization time and other complications between the two groups were analyzed.Results This study included 105 patients in the experimental group and 215 patients in the control group.All patients completed lobectomy suc-cessfully.Seventy eight pairs of patients were obtained after propensity score matching.Among them,there were 5 cases of bronchopleural fistula in the control group,with incidence rate at 6.41％.There was no bronchopleu-ral fistula in the experimental group,the difference was statistically significant(P=0.028).No death happened in the two groups.There was no significant difference in operation time and blood loss between the two groups(z=-1.774,P=0.076;z=-1.404,P=0.16).The time of carrying closed thoracic drainage tube in the ex-perimental group was significantly less than that in the control group(z=-4.725,P＜0.001),and the num-ber of cases with encapsulated pneumothorax,prolonged air leak and recatheterization in the experimental group was significantly less than that in the control group(x2=4.792,P=0.029;x2=5.347,P＜0.021;x2=5.778,P＜0.016).Conclusion Modified pedicled prepericardial fat pad covering bronchial stump has obvious advantages in preventing bronchopleural fistula in high-risk patients.It can reduce the incidence of postoperative bronchopleural fistula in high-risk patients,reduce the time of carrying closed thoracic drainage tube and postop-erative complications,and improve the prognosis and quality of life for patients.This method of operation is clin-ically feasible and is worth popularizing in clinic.
国家科技期刊平台
NSTL
万方数据
维普
