Abstract
Bronchial fistula after pulmonary resection for lung cancer is one of the most distressful complications for thoracic surgeons. To clarify effective methods and indications of conservative therapies for empyema due to bronchial fistula after pulmonary resection for lung cancer, we examined the clinical courses and therapies of 9 cases who suffered from empyema due to bronchial fistula after pulmonary resection for lung cancer between January, 1991 and December, 1995. Seven of the 9 patients underwent right lower lobectomy, 1 left lower lobectomy and 1 right upper sleeve lobectomy (one stoma type). Concerning dissection of lymph nodes, 8 patients underwent R2b dissection and 1 R1 dissection. In 6 patients (67%), the empyemas had healed by conservative therapies 14 to 67 days (mean 31.5 days) after confirmation of bronchial fistulas. All the healed cases met the following requirements : (1) A residual lobe is expected to expand. (2) Necrosis of bronchial stump is narrow. (3) There is no or only slight aspiration pneumonia in the contralateral lung. Empyema due to bronchial fistula after pulmonary resection for lung cancer can be healed by conservative therapies consisting of tube drainage (affected side below), postural drainage, effective antibiotics and intravenous hyperalimentation. In the other 3 patients (33%), wide ischemia led to bronchial necrosis from the bronchial stump to central bronchus, and aspiration pneumonia of the contralateral lung was severe. Conservative therapies were not effective and surgical procedures were indicated.
