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OBJECTIVES A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26–70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.

Introduction: Bronchial fistula (BF) after pneumonectomy – is a serious complication, associated with high mortality. Since the introduction in clinical practice the less invasive techniques for BF closure, namely vascular occluders, amplatzer sets, the abilities of BF closure have been rising. But the main issue for BF closure by the occluders is a proper selection of the device size, which defined by the BF features. Aims and Objectives: The aim of our study was to define the best method of BF measurement. Methods: Under a local anesthesia and bronchoscope control catheter sizing balloon was put in BF in such manner that x-ray plaque set up in the center of BF. Balloon was inflating by liquid contrast until the moment of waist appearing under X-ray control. Once the waist appeared, inflation of balloon was stopped and we measured the length and width of balloon waist in two projections. The size of amplatzer waist should be 30% bigger the BF size. Results: In such way we measured BF sizes in 8 of 13 patients, and these patients were successfully subjected to the procedure of occluder installation. In 5 of 13 patients the BF sizes were measured by fibrobronchoscopy (FBS) and CT-scans, and all of these 5 patients needed occluders reinstallation. Later we measured the sizes of these BF by sizing balloons and we found new sizes 30-50% bigger as compared with initial sizes, measured by CT and FBS. Reinstallation of occluders in these patients was successful and resulted in fistula closure in all cases. Conclusions: Of all the measurement methods we used, the measurement with the help of the sizing balloon and X-ray C-arm appeared to be the most accurate. The BF closure by occluders installation by this way was safe and reliable.

To present treatment of bronchial fistulas by using of occluders.For the period from March 2015 to October 2016 Atrial Septal Defect (ASD) occluders have been used for bronchial fistulas occlusion (Lepu Medical Technology Co., Ltd.; Lifetech Scientific Co., Ltd.). These are devices designed to close ventricular and atrial septal defects. The procedure was performed in 8 patients with main bronchus fistula occurred after pulmonectomy for tuberculosis in 5 patients and lung cancer in 3 patients. Fistulas' dimensions were 6-26 mm. The procedure was performed with double visualization from pleural cavity (through the thoracostomy and port-assisted approach) and from bronchial lumen.Seven out of 8 patients are currently alive (1 patient died from advanced tuberculosis of single lung). Occlusion is adequate in 6 patients, air drainage around around the occluder is noted in 1 patient. In 1 patient esophageal-pleural fistula occurred besides bronchial fistula. There was significant 2-3-fold decrease of residual pleural cavities volume and output volume. Patients feel satisfactory.Введение. Хирургические методики по закрытию свищей не всегда эффективны в силу тяжести состояния пациента. Для закрытия свищевого хода используется много разновидностей устройств, однако наиболее перспективными являются окклюдеры. материал и методы. С марта 2015 г. по октябрь 2016 г. для окклюзии свищей применялись ASD (AtrialSeptalDefect)-окклюдеры фирм 'Lepu Medical Technology Co., Ltd.'; 'Lifetech Scientific Co., Ltd.'), устройства, предназначенные для закрытия дефектов межжелудочковой и межпредсердной перегородок. Процедура была выполнена 8 пациентам со свищами главного бронха после пульмонэктомии, выполненной у 5 пациентов по поводу туберкулеза и у 3 - по поводу рака легкого. Размер свищей от 6 до 26 мм. Процедура выполнялась посредством двойной визуализации из просвета плевральной полости (через торакостому и через порт) и из просвета бронхов. Результаты. Из 8 пациентов на настоящее время живы 7 (1 пациентка умерла от прогрессирования туберкулеза в единственном легком). Сброс воздуха по свищу отсутствует у 6 пациентов, просачивание воздуха вокруг окклюдера отмечается у 1 пациента. У 1 пациента, помимо свища бронха, образовался пищеводно-плевральный свищ. Остаточные плевральные полости значительно уменьшились в объеме в 2-3 раза, количество отделяемого уменьшилось. Пациенты чувствуют себя удовлетворительно.

Background: Pneumonectomy (PE) in pulmonary tuberculosis (PTB) and aspergillosis has to be performed in cases with multiple lung cavities or destroyed lung mainly in patients infected by drug resistant microorganisms. All that resulted in a high risk of the surgery. The aim of the study is to analyze our own experience and review the available literature on this issue. Methods: The data of 64 patients subjected to PE during last 10 years is presented. Male/female ratio is 36/28. Average age is 44.7 years. Multi-drug resistance (MDR) and extensively drug resistance (XDR) was in 40 and in 20 patients respectively. Right PE was performed in 30 patients and left in 34. Bronchial stump was closed by stapling and by manual suturing in 25 ones, and in 39 patients respectively. Individual chemotherapy according to drug susceptibility test results was conducted before and after the operation. Results: Overall complication rate was 31.3% including bronchopleural fistulas (BPF) rate 14.1%. Hospital mortality rate was 6.2%. All patients with postoperative had mycobacteria tuberculosis (MBT) in their sputum specimens before the operation (P Conclusions: Our experience and data available in the literature show that PE in PTB and aspergillosis can be performed with acceptable results. It should be emphasized that in these groups of patients this operation remains the only chance to be cured.

Fistula of bronchial stump developed in 246 (9.4%) cases of 2614 patients who were underwent pneumonectomy for lung cancer in 1964-2013. Mortality rate in case of bronchial fistulae was 17.9%. It was analyzed causes of this complication, an important role of infection for its development was emphasized. So prevention of wound infection is main prophylactic action. Postoperative pneumonia and bleeding are considerable risk factors. Clinico-anatomical type of tumor, stage and technique of bronchial stump treating don't affect incidence of fistulae. Bronchial stump covering is important intraoperative preventive measure. Treatment of this complication includes early drainage and pleural cavity sanitation and isolation of fistula from pleural cavity. Endoscopic procedures (impact with silver nitrate, trichloroacetic acid, laser) are preferred to solve the last problem. It allowed to achieve fistulae healing in 58.1% of cases.Из 2614 больных, которым выполнена пневмонэктомия по поводу рака легкого в период с 1964 по 2013 г., у 246 (9,4%) оперированных развился свищ культи главного бронха, летальность при этом составила 17,9%. При анализе причин возникновения этого осложнения выявлено, что значительную роль в его развитии играют инфекции, в связи с чем основной профилактической мерой признается предупреждение развития раневой инфекции. Кроме того, существенными факторами риска являются послеоперационные пневмонии и кровотечения. Клинико-анатомическая форма опухоли и способ обработки культи бронха не влияют на частоту образования свищей. Важной мерой профилактики во время операции является укрытие культи бронха. Лечение этого осложнения заключается в скорейшем дренировании и санации плевральной полости и разобщения свищевого сообщения с плевральной полостью. Для решения последней задачи предпочтительными являются эндоскопические процедуры (воздействие нитратом серебра, трихлоруксусной кислотой, лазером), которые позволили в 58,1% добиться заживления свищей.