Skip to main content
SpringerLink
Log in

Interventionelle Versorgung tracheo-/bronchopleuraler Fisteln

Interventional treatment of tracheopleural and bronchopleural fistulas

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Bei fehlender Möglichkeit einer operativen Intervention stellt die interventionelle Bronchoskopie eine unverzichtbare Option in der Versorgung broncho- oder tracheopleuraler Fisteln dar.

Methoden

Die Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie eigenen Erfahrungen.

Ergebnisse

Zum interventionellen Verschluss broncho- oder tracheopleuraler Fisteln können verschiedene Interventionsmethoden zur Anwendung kommen. Vor allem die Implantation endobronchialer Ventile oder eines Stents haben hier aktuell einen wichtigen Stellenwert. Neben Erfahrung in der starren und flexiblen sowie der interventionellen Bronchoskopie ist ein routinierter Umgang der anästhesiologischen Kollegen mit der Hochfrequenz-Jet-Ventilation im Rahmen der Bronchoskopie und Thoraxanästhesie unbedingt erforderlich.

Diskussion

Da standardisierte Therapieempfehlungen zur interventionellen Therapie der bronchopleuralen Fistel fehlen, muss für jeden Patienten in Abhängigkeit von der Lokalisation der bronchopleuralen Fistel sowie den Komorbiditäten ein individuelles Therapiekonzept erstellt werden.

Abstract

Background

Interventional bronchoscopy is an indispensable option to manage bronchopleural and tracheopleural fistulas in patients in a poor general condition and at high risk for developing postoperative complications.

Methods

This article is based on a search in the PubMed database for relevant publications and own experiences as surgeons and pneumologists.

Results

Various interventional techniques can be used for the treatment of bronchopleural and tracheopleural fistulas. Currently, the insertion of stents or endobronchial valves is the most frequently used treatment. Ideally, the attending anesthesiologist will have experience with high frequency jet ventilation and the attending surgeon will have experience with rigid bronchoscopy, flexible bronchoscopy, and interventional bronchoscopy.

Discussion

Due to a lack of standardized treatment recommendations, individual treatment plans must be decided according to the location of the bronchopleural or tracheopleural fistula and taking existing comorbidities into account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Andreetti C, D’Andrilli A, Ibrahim M et al (2010) Submucosal injection of the silver-human albumin complex for the treatment of bronchopleural fistula. Eur J Cardiothorac Surg 37:40–43

    Article  PubMed  Google Scholar 

  2. Baumann MH, Sahn SA (1990) Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest 97:721–728

    Article  CAS  PubMed  Google Scholar 

  3. Cerfolio RJ (2001) The incidence, etiology, and prevention of postresectional bronchopleural fistula. Semin Thorac Cardiovasc Surg 13:3–7

    Article  CAS  PubMed  Google Scholar 

  4. Cordovilla R, Torracchi AM, Novoa N et al (2015) Endobronchial valves in the treatment of persistent air leak, an alternative to surgery. Arch Bronconeumol 51:10–15

    Article  PubMed  Google Scholar 

  5. Deschamps C, Bernard A, Nichols FC 3rd et al (2001) Empyema and bronchopleural fistula after pneumonectomy: Factors affecting incidence. Ann Thorac Surg 72:243–247 (discussion 248)

    Article  CAS  PubMed  Google Scholar 

  6. Dooms CA, Decaluwe H, Yserbyt J et al (2014) Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer. Eur Respir J 43:1142–1148

    Article  PubMed  Google Scholar 

  7. Ferguson JS, Sprenger K, Van Natta T (2006) Closure of a bronchopleural fistula using bronchoscopic placement of an endobronchial valve designed for the treatment of emphysema. Chest 129:479–481

    Article  PubMed  Google Scholar 

  8. Firlinger I, Stubenberger E, Müller MR et al (2013) Endoscopic one-way valve implantation in patients with prolonged air leak and the use of digital air leak monitoring. Ann Thorac Surg 95:1243–1249

    Article  PubMed  Google Scholar 

  9. Fruchter O, El Raouf BA, Abdel-Rahman N et al (2014) Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: Long-term follow-up. Respiration 87:227–233

    Article  PubMed  Google Scholar 

  10. Fruchter O, Kramer MR, Dagan T et al (2011) Endobronchial closure of bronchopleural fistulae using amplatzer devices: Our experience and literature review. Chest 139:682–687

    Article  PubMed  Google Scholar 

  11. Glover W, Chavis TV, Daniel TM et al (1987) Fibrin glue application through the flexible fiberoptic bronchoscope: Closure of bronchopleural fistulas. J Thorac Cardiovasc Surg 93:470–472

    CAS  PubMed  Google Scholar 

  12. Han X, Yin M, Li L et al (2018) Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single-center study of 148 consecutive patients. Surg Endosc 32:4116–4124

    Article  PubMed  Google Scholar 

  13. Herth FJ, Eberhardt R (2016) Airway stent: What is new and what should be discarded. Curr Opin Pulm Med 22:252–256

    Article  CAS  PubMed  Google Scholar 

  14. Herth FJ, Eberhardt R, Gompelmann D et al (2013) Radiological and clinical outcomes of using Chartis to plan endobronchial valve treatment. Eur Respir J 41:302–308

    Article  PubMed  Google Scholar 

  15. Ishikawa K, Kato T, Aragaki M et al (2013) Endobronchial closure of a bronchopleural fistula using a fibrin glue-coated collagen patch and fibrin glue. Ann Thorac Cardiovasc Surg 19:423–427

    Article  PubMed  Google Scholar 

  16. Keshishyan S, Revelo AE, Epelbaum O (2017) Bronchoscopic management of prolonged air leak. J Thorac Dis 9:S1034–S1046

    Article  PubMed  PubMed Central  Google Scholar 

  17. Klotz LV, Gesierich W, Schott-Hildebrand S et al (2015) Endobronchial closure of bronchopleural fistula using Amplatzer device. J Thorac Dis 7:1478–1482

    PubMed  PubMed Central  Google Scholar 

  18. Koster TD, Slebos DJ (2016) The fissure: Interlobar collateral ventilation and implications for endoscopic therapy in emphysema. Int J Chron Obstruct Pulmon Dis 11:765–773

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kramer MR, Peled N, Shitrit D et al (2008) Use of Amplatzer device for endobronchial closure of bronchopleural fistulas. Chest 133:1481–1484

    Article  PubMed  Google Scholar 

  20. Lois M, Noppen M (2005) Bronchopleural fistulas: An overview of the problem with special focus on endoscopic management. Chest 128:3955–3965

    Article  PubMed  Google Scholar 

  21. Majid A, Kheir F, Sierra-Ruiz M et al (2019) Assessment of fissure integrity in patients with intrabronchial valves for treatment of prolonged air leak. Ann Thorac Surg 107:407–411

    Article  PubMed  Google Scholar 

  22. Schuhmann M, Raffy P, Yin Y et al (2015) Computed tomography predictors of response to endobronchial valve lung reduction treatment. Comparison with Chartis. Am J Respir Crit Care Med 191:767–774

    Article  PubMed  Google Scholar 

  23. Seyfried U, Firlinger I, Reiter M et al (2012) A leak in the lung: Endobronchial one-way valve placement as treatment for a persistent bronchopleural fistula. Pneumologie 66:188–191

    Article  CAS  PubMed  Google Scholar 

  24. Silon B, Siddiqui AA, Taylor LJ et al (2017) Endoscopic management of esophagorespiratory fistulas: A multicenter retrospective study of techniques and outcomes. Dig Dis Sci 62:424–431

    Article  PubMed  Google Scholar 

  25. Sirbu H, Busch T, Aleksic I et al (2001) Bronchopleural fistula in the surgery of non-small cell lung cancer: Incidence, risk factors, and management. Ann Thorac Cardiovasc Surg 7:330–336

    CAS  PubMed  Google Scholar 

  26. Slebos DJ, Shah PL, Herth FJ et al (2017) Endobronchial valves for endoscopic lung volume reduction: Best practice recommendations from expert panel on endoscopic lung volume reduction. Respiration 93:138–150

    Article  PubMed  Google Scholar 

  27. Takaoka K, Inoue S, Ohira S (2002) Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 122:374–378

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Thoraxklinik am Universitätsklinikum Heidelberg gGmbH, Röntgenstraße 1, 69126, Heidelberg, Deutschland

    L. V. Klotz & H. Winter

  2. Abteilung für Pneumologie, Thoraxklinik am Universitätsklinikum Heidelberg gGmbH, Röntgenstraße 1, Heidelberg, 69126, Deutschland

    R. Eberhardt & F. J. F. Herth

  3. Translational Lung Research Center Heidelberg (TLRC‑H), Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland

    L. V. Klotz, R. Eberhardt, F. J. F. Herth & H. Winter

Authors
  1. L. V. Klotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Eberhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. J. F. Herth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. V. Klotz.

Ethics declarations

Interessenkonflikt

R. Eberhardt hat Vortragshonorare von Pulmonx/USA und Olympus Europa/Deutschland erhalten. L.V. Klotz, R. Eberhardt, F.J.F. Herth und H. Winter geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klotz, L.V., Eberhardt, R., Herth, F.J.F. et al. Interventionelle Versorgung tracheo-/bronchopleuraler Fisteln. Chirurg 90, 697–703 (2019). https://doi.org/10.1007/s00104-019-0977-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-019-0977-2

Schlüsselwörter

Keywords

Search

Navigation