2018 Volume 40 Issue 1 Pages 7-10
Background. Postoperative pulmonary fistula is sometimes refractory, and endoscopic therapy is often selected for treatment. Case. A 74-year-old man with lung cancer in the right upper lobe was treated with right upper lobectomy. A prolonged pulmonary fistula occurred postoperatively. He underwent pleurodesis with an autologous blood patch and reoperation; however, the pulmonary fistula did not disappear. Bronchoscopy revealed that the responsible bronchus was the right B4 bronchus. We performed bronchial closure using fibrin glue and an Endobronchial Watanabe Spigot (EWS). The pulmonary fistula disappeared. But, the patient expectorated the EWS. We diagnosed a recurrence of the pulmonary fistula. We performed bronchoscopic bronchial closure six times using an EWS or polyglycolic acid (PGA) sheet and fibrin glue, but the pulmonary fistula did not disappear. We then performed bronchial closure using N-butyl-2-cyanoacrylate (NBCA), fibrin glue, and a PGA sheet. The pulmonary fistula disappeared. In the three years since this bronchial closure, the patient has remained free of recurrence of the pulmonary fistula. Conclusion. Bronchoscopic bronchial closure using NBCA is therefore considered to be an effective therapy for postoperative refractory pulmonary fistula.
