Successful Treatment with Fenestration and Multi-professional Intervention for a Large Bronchopleural Fistula

Abstract

A 71-year-old man underwent right lower lobectomy for right lower lung cancer and was discharged. On the 15th day after the surgery, he was urgently brought into our hospital due to impaired consciousness and respiratory failure. Bronchoscopic examination showed the bronchial stump to have completely opened. It was determined that the fistula could not be closed on one-stage operation, so after intervention of a nutritional support team and physiotherapists, fenestration was performed. As a result, 7 days after fenestration, a mechanical ventilator was no longer necessary, and walking training was started. Two months after the surgery, the bronchial stump was almost covered with surrounding tissues. The addition of 4 weeks' negative pressure wound therapy (NPWT) resulted in complete disappearance of the residual pleural cavity and wound epithelialization. The reasons for the successful closure of the fistula in a relatively short time after fenestration were that perioperative nutritional status was generally good, the volume of the remaining right upper and middle lobe was large, and the pleural cavity reduced as the empyema cleared. Perioperative active participation of each occupation was also important. NPWT was effective in reducing the residual pleural cavity.