ABSTRACT
A strategy providing for solution of a number of tactical and technical problems involved in prognosis, prevention and management of postoperative bronchopleural complication after pneumonectomy for lung cancer was suggested. It was followed by a significant decrease in the frequency of bronchopleural fistula, postoperative empyema and lethality from purulent bronchopleural complications.
Subject(s)
Bronchial Fistula/therapy , Empyema, Pleural/therapy , Lung Neoplasms/surgery , Postoperative Complications/therapy , Adult , Aged , Algorithms , Bronchial Fistula/diagnosis , Bronchial Fistula/prevention & control , Combined Modality Therapy , Empyema, Pleural/diagnosis , Empyema, Pleural/prevention & control , Female , Humans , Male , Middle Aged , Pneumonectomy , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , SuppurationABSTRACT
The present paper presents 5 microscopic investigations of the morphology of a major bronchial stump area or tracheobronchial anastomosis after tightly fixing a vascularized diaphragmatic or omental flap. The cadaveric material of female patients who had died in different periods after diaphragmopexy or omentopexy was investigated. The authors' observations support the fact that diaphragmatic or omental flaps tightly sutured to the tracheobronchial wall can provide its revascularization and regeneration of the bronchial stump or tracheobronchial anastomosis.
Subject(s)
Bronchi/pathology , Diaphragm/surgery , Lung Neoplasms/surgery , Omentum/surgery , Surgical Flaps/pathology , Diaphragm/pathology , Humans , Male , Middle Aged , Omentum/pathology , PneumonectomyABSTRACT
Use of vascular flap to cover the principal bronchus stump for prevention of bronchopleural fistula is generally known. To provide objective evidence on relevant indications, a multivariate analysis of 14 potential risk factors of suture failure was undertaken. Right-side surgery and preoperative irradiation appeared to be significant (p<0,05) factors of high risk (over 25%) for stump suture failure. Either risk factor may be regarded as indication for making preventive plastic cover.
