[Transbronchoscopic balloon detection and selective bronchial occlusion for intractable pneumothorax].

Objective: To evaluate the effect, complications and safety of transbronchoscopic balloon detection (TBD) and selective bronchus occlusion (SBO) for intractable pneumothorax.

Methods: Forty cases of pneumothorax from 5 teaching hospitals in Fujian province were included for this study. TBD was performed in all the 40 cases for whom chest tube drainage had lasted for more than 7days but failed to close the pleura fistulae. Bronchi leading to pleura fistulae (the target bronchus) were detected by balloon-catheter (Olympus B7-2C) through bronchoscope. After the target bronchus was located, SBO procedures were performed. Autologous blood (20 ml to 30 ml) was injected into the target bronchus and followed by thrombin solution (1000 U) through balloon-catheter. In 10 cases, oxygenation and pulse rate were recorded by pulse-oximeter (Healthdyne 920M) during TBD and SBO. Another 10 cases undergoing bronchoscope without performing TBD and SBO served as the controls. Thorax CT, white blood cell count, neutrophil count and body temperature were measured after SBO.

Results: Bronchi leading to pleura fistulae were located by TBD in 34 out of the 40 cases. Air leakage was stopped after the first occlusion in 30 cases, but 5 of which underwent a second occlusion because of recurrence in 72 h. Of the 5 cases, air leakage was stopped in 3, and surgery was required in 2. Taken together, 28 of the 34 cases were cured by SBO and 6 failed. There were no statistically differences between the treatment group and the control group in oxygenation changes during TBD and SBO procedures. In 10 cases thorax CT scan was followed up in 7 days after SBO, and no obstructive atelectasis was found. In 20 cases peripheral white blood cell count was followed up 72 hours after SBO. Leukocytosis (> 10.0 x 10(9)/L) was found in 3, in which pulmonary infection was diagnosed, and leukocytosis was present in 2 cases before the procedure. Five patients (5/34) experienced mild to moderate fever, which resolved quickly.

Conclusion: TBD/SBO are safe and effective procedures for intractable pneumothorax.