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Vol. 34. Issue 1.
Pages 17-22 (January 1998)
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Vol. 34. Issue 1.
Pages 17-22 (January 1998)
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Abordaje de la fístula broncopleural en pacientes intervenidos de cáncer de pulmón. Estudio prospectivo
Approach to bronchopleural fístula in patients undergoing lung cancer surgery. A prospective study
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A. Arnau Obrer*, E. Martín Díaz, P. Martínez Vallina, A. Cantó Armengod
Servicios de Cirugía Torácica, Hospital General Universitario de Valencia
G.R. Rico Portalésa, M.V. Granell Gila, R. García Aguadoa, R.V. Lluch Motab
a Servicios de Cirugía Torácica, Anestesia y Reanimación, Hospital General Universitario de Valencia
b Servicios de Cirugía Torácica, Neumología. Hospital General Universitario de Valencia
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Arch Bronconeumol. 1998;34:12210.1016/S0300-2896(15)30467-1
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Ocurrieron 24 casos de fístula broncopleural (FBP) confirmados mediante fíbrobroncoscopia en 526 pacientes intervenidos consecutivamente por cáncer de pulmón con finalidad diagnóstica y/o terapéutica entre febrero de 1990 y enero de 1997 en el Hospital General Universitario de Valencia, practicándose exéresis reglada de pulmón en 327.

Clínicamente cursaron con fiebre, expectoración purulenta o hemoptoica, dolor torácico, disnea y malestar general, asociándose el 83,33% de los casos a empiema pleural.

El drenaje pleural y la antibioterapia de amplio espectro, junto a un planteamiento quirúrgico adecuado a cada paciente, fueron la base del tratamiento. El apartado quirúrgico consistió en retoracotomía y cierre bronquial en los casos precoces sin signos de infección (<48h); toracostomía (Clagett) en los casos de infección pleural comprobada, asociada a plastia muscular bronquial en un segundo tiempo; toraco-plastia en aquellos casos de fístulas incompletas no resueltas mediante el drenaje pleural. En un caso se utilizó colas biológicas mediante fibrobroncoscopia.

Se estudia la incidencia de FBP analizando los factores asociados a su presentación y los resultados obtenidos tras las distintas técnicas quirúrgicas aplicadas.

Palabras clave:
Fístula broncopleral
Cáncer de pulmón
Empiema pleural

Twenty-four cases of bronchopleural fistula were found by fiberoptic bronchoscopy performed in 526 consecutive patients undergoing surgery for diagnosis or treatment of lung cancer between February 1990 and January 1997 in Hospital General Universitario in Valencia (Spain). In 327 of the patients lung resection was performed.

Clinical symptoms included fever, purulent or bloodstained expectoration, chest pain, dyspnea and general unfitness, with 83.33% of the patients having pleural empyema.

Treatment was based on pleural drainage and broad-spectrum antibiotic therapy, along with planning of the appropriate surgery technique to each patient. Surgery consisted in re-thoracotomy and bronchial closure in early detection cases without evidence of infection (<48h); thoracostomy (Clagett) and second stage myoplasty if confirmed pleural infection; thoracoplasty in cases of incomplete fistulas that were unresolved by pleural drainage. Biological glues were delivered by fiberoptic bronchoscope in one patient.

The incidence of bronchopleural fistula was studied, as were associated factors and the results obtained by various surgical techniques.

Key words:
Bronchopleural fistula
Lung cancer
Pleural empyema
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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