Abordaje transesternal transpericárdico para el cierre de la fístula broncopleural tardía y manejo del empiema crónico asociado con tuberculosis
Palabras clave:
tuberculosis pulmonar, fístula bronquial, empiema pleural, procedimientos quirúrgicos pulmonaresResumen
El 33,33% de la población mundial padece de tuberculosis y aproximadamente dos millones de personas mueren al año por esta enfermedad. En Colombia, su prevalencia es 23,4 por cada 100.000 habitantes. Algunas complicaciones requieren manejo quirúrgico. Sin embargo, la anatomía de los pacientes tuberculosos es compleja debido a fibrosis en el hilio pulmonar.
Materiales y métodos: Una revisión de literatura encontró 140 pacientes con abordaje transmediastinal transpericárdico para el cierre de una fístula broncopleural tardía post-neumonectomía, descritos en diez series en los últimos 25 años; diez pacientes presentaron tuberculosis. La mortalidad perioperatoria (14%) y recurrencia a cinco años (10%), y la mayoría de los casos se presentaron en los primeros seis meses.
Discusión: La fístula broncopleural es una complicación fatal posterior a una neumonectomía en pacientes tuberculosos; la de presentación tardía compromete gravemente la calidad de vida y se asocia con proceso inflamatorio severo en el hilio pulmonar. Su manejo requiere una vía alternativa 'virgen' para lograr una disección precisa y segura del hilio pulmonar. La mortalidad perioperatoria (14%) y recurrencia (10%) son comparables a los resultados obtenidos con transposición intratorácica de colgajos músculo-cutáneo y de epiplón en la fístula broncopleural temprana.
Conclusión: El abordaje transmediastinal transpericárdico se puede hacer de una manera segura y usar en el manejo de la fístula broncopleural tardía posterior a neumonectomía por tuberculosis.
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Referencias bibliográficas
1. WHO. Global Tuberculosis Surveillance -Planning, Finance, Who Report 2005.
2. Min Protección Social. Boletín del Ministerio de la Protección Social, Colombia: Ministerio de la Protección Social, Colombia, 2005
3. WHO. World Health Organization TB Country Epidemiology Profile as March 8, 2005.
4. Freixinet J, Rivas J, Rodríguez De Castro F, et al. Role of surgery in pulmonary tuberculosis. Med Sci Monit 2002; 8: CR782-786.
5. Campana JM. Fístulas traqueoesofágicas en el adulto. Tracheoesophageal fistula in the adult Rev Argent Cir 1983; 44: 224-229.
6. Braghetto I, Vargas M, Rojas J, et al. Tuberculous esophagobronchial fistulae: review. Arq Bras Cir Dig 1994; 9: 110-115.
7. Álvarez R, Rocabado J, Castillo M, et al. Reparación protésica de pared posterior de tráquea por destrucción secundaria a tuberculosis esofágica / Prosthetic repair of posterior tracheal wall by secondary destruction due to esophageal tuberculosis. Cuad Cir 1996; 10: 24-27.
8. Stafford E, Clagett O. Postpneumonectomy emphyema. Neomycin instillation and definitive closure. J Thorac Cardiovasc Surg 1972; 63: 771-775.
9. Eloesser L. An operation for tuberculous empyema. Surg Gynecol Obst 1935; 60: 1096-1097.
10. Eloesser L. Of an operation for tuberculous empyema. Ann Thorac Surg 1969; 8: 355-357.
11. Deslauriers J, Jacques L, Gregoire J. Role of Eloesser flap and thoracoplasty in the third millennium. Chest Surg Clin N Am 2002; 12: 605-623.
12. Thourani VH, Lancaster RT, Mansour KA, et al. Twenty-six years of experience with the modified Eloesser flap. Ann Thorac Surg 2003; 76: 401-406.
13. Clagett O, Geraci J. A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg 1963; 45: 141-145.
14. Shamji F, Ginsberg R, Cooper J, et al. Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula. J Thorac Cardiovasc Surg 1983; 86: 818-822.
15. Deschamps C, Pairolero P, Allen M, et al. Management of postpneumonectomy empyema and bronchopleural fistula. Chest Surg Clin N Am 1996; 6: 519-527.
16. Pairolero P, Arnold P, Piehler J. Intrathoracic transposition of extrathoracic skeletal muscle. J Thorac Cardiovasc Surg 1983; 86: 809-817.
17. Hankins J, Miller J, McLaughlin J. The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients. Ann Thorac Surg 1978; 25: 491-499.
18. Pairolero P, Arnold P, Trastek V, et al. Postpneumonectomy empyema. The role of intrathoracic muscle transposition. J Thorac Cardiovasc Surg 1990; 99: 958-968.
19. Arnold P, Pairolero P. Intrathoracic muscle flaps. An account of their use in the management of 100 consecutive patients. Ann Surg 1990; 211: 656-662.
20. Visbal A, Quintero M, Garzón J, et al. Uso de los colgajos musculares en la enfermedad pleuropulmonar infecciosa complicada. Rev Col Neumol Cir Torax 2004; 16: 42-50.
21. Janeiro J, Pavón J, Vargas A. Primera experiencia clínica en México con un sello de fibrina / First clinical experience in Mexico with the use of fibrin glue. Cir Gen 1997; 19: 103-108.
22. Torre M, Chiesa G, Ravini M, et al. Endoscopic gluing of bronchopleural fistula. Ann Thorac Surg 1987; 43: 295-297.
23. Hollaus PH, Lax F, El-Nashef BB, et al. Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 1997; 63: 1391-1396.
24. Hankins J, Miller J, Attar S, et al. Bronchopleural fistula. Thirteen-year experience with 77 cases. J Thorac Cardiovasc Surg 1978; 76: 755-762.
25. Patterson G, Cooper J, Dark J, et al. Experimental and clinical double lung transplantation. J Thorac Cardiovasc Surg 1988; 95: 70-74.
26. Shrager JB, Wain JC, Wright CD, et al. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg 2003; 125: 526-532.
27. Vencevicius V, Grazelis E, Serpytis J, et al. The surgical treatment of lung tuberculosis(Article in Lithuanian). Medicina (Kaunas) 2002; 38 Suppl 2: 30-32.
28. Goeltz F. "Successful anterior thoraco-bronchotomy for a foreign body impacted in the bronchus". Ann Surg Oncol 1907; 43: 369-372.
29. Padhi R, Lynn R. The management of bronchopleural fistulas. J Thorac Cardiovasc Surg 1960; 39: 385-393.
30. Abruzzini P. "Trattamento chirurgico delle fistule del bronco principale consecutive a pneumonectomia per tuberculosi". Chir Torac 1961; 14: 165-171.
31. Nagamine I, Uemura H, Kawata S, et al. (New surgical method for bronchial fistula after unilateral pneumonectomy. Transmediastinal approach by splitting the sternum to the bronchial stump)(Article in Japanese). Kyobu Geka 1967; 20: 67-69.
32. Perelman MI, Ambatjello GP. Transpleural, transsternal and contralateral approach in surgery of bronchial fistulas following pneumonectomy. Thoraxchirurgie, Vaskulare Chirurgie 1970; 18: 45-57.
33. Bogusch L. (Indication and results of transpericardial surgery of main bronchi and pulmonary vessels)(Article in German). Z Erkr Atmungsorgane Folia Bronchol 1970; 131: 275-277.
34. Brigand H, Levasseur P, Luizy J. Traitement chirugical de la tuberculosee pulmonaire. Encyclopédie médico-chirurgicale: Editions Techniques 1972; 1-18.
35. Maassen W. (The transsternal and transpericardial approach for surgical treatment of fistulas of the main bronchus after pneumonectomy (author's transl))(Article in German). Thoraxchir Vask Chir 1975; 23: 257-261.
36. Anderson R, Li W. Anterior transpericardial closure of a main bronchus fistula after pneumonectomy. Am J Surg 1983; 145: 630-632.
37. Ravitch M, Steichen F. Transpericardial approach to the right main bronchus. In: Atlas of General Thoracic Surgery. W.B. Saunders Company, 1988; 250-253.
38. Grillo HC. Development of tracheal surgery: a historical review. Part 1: techniques of tracheal surgery. Ann Thorac Surg 2003; 75: 610-619.
39. Pearson F, Todd T, Cooper J. Experience with primary neoplasms of the trachea and carina. J Thorac Cardiovasc Surg 1984; 88: 511-518.
40. Morimoto K, Taniguchi I, Nakamura Y, et al. Transparasternal transpericardial operation in the treatment of chronic empyema with bronchopleural fistula. Japanese J Thorac Cardiovasc Surg 2002; 50: 246-248.
41. Refaely Y, Paley M, Simansky D, et al. Transsternal transpericardial closure of a postlobectomy bronchopleural fistula. Ann Thorac Surg 2002; 73:635-636
42. Stella F, Petrella F. Transsternal transpericardial approach for acute descending necrotizing mediastinitis. J Thorac Cardiovasc Surg 2005; 129: 212-214.
43. Ginsberg RJ, Griffith Pearson F, Cooper JD, et al. Closure of chronic postpneumonectomy bronchopleural fistula using the transsternal transpericardial approach. Ann Thorac Surg 1989; 47: 231-235.
44. Athanassiadi K, Vassilikos K, Misthos P, et al. Late postpneumonectomy bronchopleural fistula. Thorac Cardiovasc Surg 2004; 52: 298-301.
45. Stamatis G, Martini G, Freitag L, et al. Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy. Eur J Cardiothorac Surg 1996; 10: 83-86.
46. de la Riviere B, Defauw JJ, Knaepen PJ, et al. Transsternal closure of bronchopleural fistula after pneumonectomy. Ann Thorac Surg 1997; 64: 954-958.
47. Darling GE, Abdurahman A, Yi Q-L, et al. Risk of a right pneumonectomy: role of bronchopleural fistula. Ann Thorac Surg 2005; 79: 433-437.
48. Opitz I, Kestenholz P, Lardinois D, et al. Incidence and management of surgical complications after induction chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Lung Cancer 2005; 49: S226.
49. Flores R, Zakowski M, Venkatramen E, et al. Malignant pleural mesothelioma (MPM): New predictors of survival and an analysis of the impact of current treatment. Lung Cancer 2005; 49: S28.
50. Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg 2004; 128: 138-146.
51. Rusch VW, Rosenzweig K, Venkatraman E, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2001; 122:788-795
52. Miller D, Deschamps C, Jenkins G, et al. Completion pneumonectomy: factors affecting operative mortality and cardiopulmonary morbidity. Ann Thorac Surg 2002; 74: 876-883.
53. Jungraithmayr W, Hasse J, Olschewski M, et al. Indications and results of completion pneumonectomy. Eur J Cardiothorac Surg 2004; 26: 189-196.
54. Guggino G, Doddoli C, Barlesi F, et al. Completion pneumonectomy in cancer patients: experience with 55 cases. Eur J Cardiothorac Surg 2004; 25: 449-455.
55. Sherwood JT, Mitchell JD, Pomerantz M. Completion pneumonectomy for chronic mycobacterial disease. J Thorac Cardiovasc Surg 2005; 129: 1257-1264.
56. Mullins M, Walker I, Standridge R. Using povidone-iodine to treat empyema. J Wound Care 2001; 10: 155-156.
57. Baldwin JC, Mark JBD. Treatment of bronchopleural fistula after pneumonectomy. J Thorac Cardiovasc Surg 1985; 90: 813-817.
58. Beltrami V, Angelici A, Bertagni A, et al. Transsternal approach to closure of bronchopleural fistulas after pneumonectomy. A fifteen cases report. Lung Cancer 2000; 29: 43-47.
59. Topcuoglu MS, Kayhan C, Ulus T. Transsternal transpericardial approach for the repair of bronchopleural fistula with empyema. Ann Thorac Surg 2000; 69: 394-397.
2. Min Protección Social. Boletín del Ministerio de la Protección Social, Colombia: Ministerio de la Protección Social, Colombia, 2005
3. WHO. World Health Organization TB Country Epidemiology Profile as March 8, 2005.
4. Freixinet J, Rivas J, Rodríguez De Castro F, et al. Role of surgery in pulmonary tuberculosis. Med Sci Monit 2002; 8: CR782-786.
5. Campana JM. Fístulas traqueoesofágicas en el adulto. Tracheoesophageal fistula in the adult Rev Argent Cir 1983; 44: 224-229.
6. Braghetto I, Vargas M, Rojas J, et al. Tuberculous esophagobronchial fistulae: review. Arq Bras Cir Dig 1994; 9: 110-115.
7. Álvarez R, Rocabado J, Castillo M, et al. Reparación protésica de pared posterior de tráquea por destrucción secundaria a tuberculosis esofágica / Prosthetic repair of posterior tracheal wall by secondary destruction due to esophageal tuberculosis. Cuad Cir 1996; 10: 24-27.
8. Stafford E, Clagett O. Postpneumonectomy emphyema. Neomycin instillation and definitive closure. J Thorac Cardiovasc Surg 1972; 63: 771-775.
9. Eloesser L. An operation for tuberculous empyema. Surg Gynecol Obst 1935; 60: 1096-1097.
10. Eloesser L. Of an operation for tuberculous empyema. Ann Thorac Surg 1969; 8: 355-357.
11. Deslauriers J, Jacques L, Gregoire J. Role of Eloesser flap and thoracoplasty in the third millennium. Chest Surg Clin N Am 2002; 12: 605-623.
12. Thourani VH, Lancaster RT, Mansour KA, et al. Twenty-six years of experience with the modified Eloesser flap. Ann Thorac Surg 2003; 76: 401-406.
13. Clagett O, Geraci J. A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg 1963; 45: 141-145.
14. Shamji F, Ginsberg R, Cooper J, et al. Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula. J Thorac Cardiovasc Surg 1983; 86: 818-822.
15. Deschamps C, Pairolero P, Allen M, et al. Management of postpneumonectomy empyema and bronchopleural fistula. Chest Surg Clin N Am 1996; 6: 519-527.
16. Pairolero P, Arnold P, Piehler J. Intrathoracic transposition of extrathoracic skeletal muscle. J Thorac Cardiovasc Surg 1983; 86: 809-817.
17. Hankins J, Miller J, McLaughlin J. The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients. Ann Thorac Surg 1978; 25: 491-499.
18. Pairolero P, Arnold P, Trastek V, et al. Postpneumonectomy empyema. The role of intrathoracic muscle transposition. J Thorac Cardiovasc Surg 1990; 99: 958-968.
19. Arnold P, Pairolero P. Intrathoracic muscle flaps. An account of their use in the management of 100 consecutive patients. Ann Surg 1990; 211: 656-662.
20. Visbal A, Quintero M, Garzón J, et al. Uso de los colgajos musculares en la enfermedad pleuropulmonar infecciosa complicada. Rev Col Neumol Cir Torax 2004; 16: 42-50.
21. Janeiro J, Pavón J, Vargas A. Primera experiencia clínica en México con un sello de fibrina / First clinical experience in Mexico with the use of fibrin glue. Cir Gen 1997; 19: 103-108.
22. Torre M, Chiesa G, Ravini M, et al. Endoscopic gluing of bronchopleural fistula. Ann Thorac Surg 1987; 43: 295-297.
23. Hollaus PH, Lax F, El-Nashef BB, et al. Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 1997; 63: 1391-1396.
24. Hankins J, Miller J, Attar S, et al. Bronchopleural fistula. Thirteen-year experience with 77 cases. J Thorac Cardiovasc Surg 1978; 76: 755-762.
25. Patterson G, Cooper J, Dark J, et al. Experimental and clinical double lung transplantation. J Thorac Cardiovasc Surg 1988; 95: 70-74.
26. Shrager JB, Wain JC, Wright CD, et al. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg 2003; 125: 526-532.
27. Vencevicius V, Grazelis E, Serpytis J, et al. The surgical treatment of lung tuberculosis(Article in Lithuanian). Medicina (Kaunas) 2002; 38 Suppl 2: 30-32.
28. Goeltz F. "Successful anterior thoraco-bronchotomy for a foreign body impacted in the bronchus". Ann Surg Oncol 1907; 43: 369-372.
29. Padhi R, Lynn R. The management of bronchopleural fistulas. J Thorac Cardiovasc Surg 1960; 39: 385-393.
30. Abruzzini P. "Trattamento chirurgico delle fistule del bronco principale consecutive a pneumonectomia per tuberculosi". Chir Torac 1961; 14: 165-171.
31. Nagamine I, Uemura H, Kawata S, et al. (New surgical method for bronchial fistula after unilateral pneumonectomy. Transmediastinal approach by splitting the sternum to the bronchial stump)(Article in Japanese). Kyobu Geka 1967; 20: 67-69.
32. Perelman MI, Ambatjello GP. Transpleural, transsternal and contralateral approach in surgery of bronchial fistulas following pneumonectomy. Thoraxchirurgie, Vaskulare Chirurgie 1970; 18: 45-57.
33. Bogusch L. (Indication and results of transpericardial surgery of main bronchi and pulmonary vessels)(Article in German). Z Erkr Atmungsorgane Folia Bronchol 1970; 131: 275-277.
34. Brigand H, Levasseur P, Luizy J. Traitement chirugical de la tuberculosee pulmonaire. Encyclopédie médico-chirurgicale: Editions Techniques 1972; 1-18.
35. Maassen W. (The transsternal and transpericardial approach for surgical treatment of fistulas of the main bronchus after pneumonectomy (author's transl))(Article in German). Thoraxchir Vask Chir 1975; 23: 257-261.
36. Anderson R, Li W. Anterior transpericardial closure of a main bronchus fistula after pneumonectomy. Am J Surg 1983; 145: 630-632.
37. Ravitch M, Steichen F. Transpericardial approach to the right main bronchus. In: Atlas of General Thoracic Surgery. W.B. Saunders Company, 1988; 250-253.
38. Grillo HC. Development of tracheal surgery: a historical review. Part 1: techniques of tracheal surgery. Ann Thorac Surg 2003; 75: 610-619.
39. Pearson F, Todd T, Cooper J. Experience with primary neoplasms of the trachea and carina. J Thorac Cardiovasc Surg 1984; 88: 511-518.
40. Morimoto K, Taniguchi I, Nakamura Y, et al. Transparasternal transpericardial operation in the treatment of chronic empyema with bronchopleural fistula. Japanese J Thorac Cardiovasc Surg 2002; 50: 246-248.
41. Refaely Y, Paley M, Simansky D, et al. Transsternal transpericardial closure of a postlobectomy bronchopleural fistula. Ann Thorac Surg 2002; 73:635-636
42. Stella F, Petrella F. Transsternal transpericardial approach for acute descending necrotizing mediastinitis. J Thorac Cardiovasc Surg 2005; 129: 212-214.
43. Ginsberg RJ, Griffith Pearson F, Cooper JD, et al. Closure of chronic postpneumonectomy bronchopleural fistula using the transsternal transpericardial approach. Ann Thorac Surg 1989; 47: 231-235.
44. Athanassiadi K, Vassilikos K, Misthos P, et al. Late postpneumonectomy bronchopleural fistula. Thorac Cardiovasc Surg 2004; 52: 298-301.
45. Stamatis G, Martini G, Freitag L, et al. Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy. Eur J Cardiothorac Surg 1996; 10: 83-86.
46. de la Riviere B, Defauw JJ, Knaepen PJ, et al. Transsternal closure of bronchopleural fistula after pneumonectomy. Ann Thorac Surg 1997; 64: 954-958.
47. Darling GE, Abdurahman A, Yi Q-L, et al. Risk of a right pneumonectomy: role of bronchopleural fistula. Ann Thorac Surg 2005; 79: 433-437.
48. Opitz I, Kestenholz P, Lardinois D, et al. Incidence and management of surgical complications after induction chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Lung Cancer 2005; 49: S226.
49. Flores R, Zakowski M, Venkatramen E, et al. Malignant pleural mesothelioma (MPM): New predictors of survival and an analysis of the impact of current treatment. Lung Cancer 2005; 49: S28.
50. Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg 2004; 128: 138-146.
51. Rusch VW, Rosenzweig K, Venkatraman E, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2001; 122:788-795
52. Miller D, Deschamps C, Jenkins G, et al. Completion pneumonectomy: factors affecting operative mortality and cardiopulmonary morbidity. Ann Thorac Surg 2002; 74: 876-883.
53. Jungraithmayr W, Hasse J, Olschewski M, et al. Indications and results of completion pneumonectomy. Eur J Cardiothorac Surg 2004; 26: 189-196.
54. Guggino G, Doddoli C, Barlesi F, et al. Completion pneumonectomy in cancer patients: experience with 55 cases. Eur J Cardiothorac Surg 2004; 25: 449-455.
55. Sherwood JT, Mitchell JD, Pomerantz M. Completion pneumonectomy for chronic mycobacterial disease. J Thorac Cardiovasc Surg 2005; 129: 1257-1264.
56. Mullins M, Walker I, Standridge R. Using povidone-iodine to treat empyema. J Wound Care 2001; 10: 155-156.
57. Baldwin JC, Mark JBD. Treatment of bronchopleural fistula after pneumonectomy. J Thorac Cardiovasc Surg 1985; 90: 813-817.
58. Beltrami V, Angelici A, Bertagni A, et al. Transsternal approach to closure of bronchopleural fistulas after pneumonectomy. A fifteen cases report. Lung Cancer 2000; 29: 43-47.
59. Topcuoglu MS, Kayhan C, Ulus T. Transsternal transpericardial approach for the repair of bronchopleural fistula with empyema. Ann Thorac Surg 2000; 69: 394-397.
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2006-06-20
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Visbal, A. L.; Sánchez, R. Abordaje Transesternal transpericárdico Para El Cierre De La fístula Broncopleural tardía Y Manejo Del Empiema crónico Asociado Con Tuberculosis. Rev Colomb Cir 2006, 21, 87-96.
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