Surgical endoscopy · 2025
Three-dimensional printing-assisted Amplatzer II-type occluder or coil therapy for peripheral bronchopleural fistula.
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Li Zongming, Tang Zhigang, Li Yahua, Li Yifan, Jin Tengfei, Yao Yangduan, Tang Hongtao, Ren Kewei
Аннотация
OBJECTIVE: To explore the feasibility and safety of using 3D-printed models to assist in the treatment of refractory peripheral bronchopleural fistulas with Amplatzer II-type occluders or coils.
METHODS: This was a retrospective analysis of 13 patients-10 males (76.9%) and 3 females (23.1%)-with an average age of 65.62 ± 12.30 years (34-83 years), who were treated at our center between April 2023 and August 2024 for peripheral bronchopleural fistulas. Primary diseases included lung cancer, esophageal cancer, severe pneumonia, and pulmonary hydatid disease. The fistulas were located in the right lung in 6 patients (46.2%) and in the left lung in 7 patients (53.8%), with a total of 19 fistulas in 13 patients. All the patients were diagnosed, with their fistula locations identified using 3D-printed models combined with tracheoscopic thoracic drainage tube injection of methylene blue, and were treated with Amplatzer II-type occluders or coils.
RESULTS: All 19 fistulas were successfully occluded in a single attempt, with a technical success rate of 100%; coils were used in 4 patients (21.1%) and Amplatzer II-type occluders in 15 patients (78.9%). In 12 patients (12/13, 92.3%), the empyema cavities closed or were successfully drained without fluid, allowing for the removal of chest drainage tubes. In one patient (1/13, 7.7%), despite the occluder being well placed, there was no significant improvement in subcutaneous or mediastinal air accumulation, resulting in a clinical success rate of 92.3%. One month post-operation, significant differences in body temperature, white blood cell count, and performance status (PS) score were noted compared with preoperation values.
CONCLUSION: 3D printing aids in the diagnosis and localization of peripheral bronchopleural fistulas. The use of vascular plugs or coils for occlusion treatment is safe and effective and is worthy of clinical promotion.
METHODS: This was a retrospective analysis of 13 patients-10 males (76.9%) and 3 females (23.1%)-with an average age of 65.62 ± 12.30 years (34-83 years), who were treated at our center between April 2023 and August 2024 for peripheral bronchopleural fistulas. Primary diseases included lung cancer, esophageal cancer, severe pneumonia, and pulmonary hydatid disease. The fistulas were located in the right lung in 6 patients (46.2%) and in the left lung in 7 patients (53.8%), with a total of 19 fistulas in 13 patients. All the patients were diagnosed, with their fistula locations identified using 3D-printed models combined with tracheoscopic thoracic drainage tube injection of methylene blue, and were treated with Amplatzer II-type occluders or coils.
RESULTS: All 19 fistulas were successfully occluded in a single attempt, with a technical success rate of 100%; coils were used in 4 patients (21.1%) and Amplatzer II-type occluders in 15 patients (78.9%). In 12 patients (12/13, 92.3%), the empyema cavities closed or were successfully drained without fluid, allowing for the removal of chest drainage tubes. In one patient (1/13, 7.7%), despite the occluder being well placed, there was no significant improvement in subcutaneous or mediastinal air accumulation, resulting in a clinical success rate of 92.3%. One month post-operation, significant differences in body temperature, white blood cell count, and performance status (PS) score were noted compared with preoperation values.
CONCLUSION: 3D printing aids in the diagnosis and localization of peripheral bronchopleural fistulas. The use of vascular plugs or coils for occlusion treatment is safe and effective and is worthy of clinical promotion.