[Study of postoperative bronchopleural fistulas--analysis of factors related to bronchopleural fistulas]

Postoperative bronchopleural fistulas, although reduced in incidence, remain as a grave complication of pulmonary resection. In our department, cases of lung cancer have been rapidly increasing and those of infectious diseases have been decreasing. In light of this trend, the causes of bronchopleural fistulas may have changed, and thus we studied recent cases of postoperative bronchopleural fistulas from 1982 to 1986. Bronchopleural fistulas were seen in 5 (7.8%) of 64 cases of inflammatory diseases and in 19 (4%) of 481 cases of lung cancer. In lung cancer, bronchopleural fistulas were more frequently seen with advanced cases, especially in cases of residual tumors on the stump and in cases of intrathoracic use of anticancer drugs. The highest incidences of bronchopleural fistulas were seen with right pneumonectomy and right lower lobectomy. Bronchoscopic examination showed bronchopleural fistulas to be mainly located on the stump beside the residual lobe. When Sweet's procedure is employed, this is the point with the most tension on the stump. Clinical and retrospective analysis of preoperative data revealed the following factors to be significantly higher in cases of bronchopleural fistulas than in cases of non-bronchopleural fistulas: fever, use of steroid hormone, Haemophilus influenzae in sputum, elevation of erythrocyte sedimentation ratio and anemia. Such analysis of postoperative data showed the following factors to be significant: fever, use of steroid hormone, leucocytosis, tracheostomy and bronchoscopy for sputum suction.