7．術後気管支断端瘻の予防・診断における留意点と発生時の対策

Risk Factors, Prevention, Diagnosis, and Treatment of Bronchopleural Fistula After Lung Resection

日本胸部外科学会全国調査による2018年肺癌手術症例の検討で，術後気管支断端瘻による死亡は，肺癌手術44,859例中13例の報告1）がある．全死亡は270例で，気管支断端瘻は間質性肺炎，肺炎，心血管障害，呼吸不全に次ぐ第5位となっている．死亡にはいたらなくても実際に気管支断端瘻を起こした症例はもっと多いはずであり，予防と早期診断，発症後の適切な治療で，さらに死亡例を減らすことが可能と思われる．

Postoperative bronchopleural fistula （BPF） is a rare but severe and sometimes life-threatening complication that needs immediate and proper treatment. Thoracic surgeons should strictly manage the comorbidities such as diabetes mellitus for BPF prevention. Also, coverage of the bronchial stump with pericardial fat tissue will prevent BPF, or at least prevent the turning severe of BPF. However, when BPF occurs, we must promptly determine whether to perform conservative treatment or invasive treatment such as fenestration.