[Bronchial fistula postpneumonectomy: predictive factors].
OBJECTIVE
To determine predictive factors of bronchial fistula following pneumonectomy.


METHODS
In 14 years (1989-2003), we collect 58 cases of bronchial fistula following 725 consecutive pneumonectomy in the service of thoracic surgery of the Sainte Marguerite Hospital in Marseilles. There were 53 cases (91.4%) of cancers and 5 cases (8.6%) of various pathology. The average age of the patients was of 61 +/- 10 years (range 24 to 80 years). The sex ratio M/F was 8.7. The software of regression SPSS (version11.5) was used to identify the factors risk of a bronchial fistula after a univariate and multivariate analysis.


RESULTS
The prevalence of the bronchial fistula after a pneumonectomy was 8%.The preoperative factors which increased to a significant degree the incidence of the bronchial dent to the univariate analysis were the chronic smoking (P < 0.001), the existence of COPD (P = 0.001) and of a previous thoracic surgery (P = 0.01). Operational data like a right- side pulmonary resection (P < 0.001), the type of bronchial stup carried out (P = 0.03) as and an extended pneumonectomy to the auricule (P = 0.03) were significant risk factors. With the logistic regression the significant risk factors were the chronic smoking (P = 0.002), the existence of COPD (P = 0.003), a previous pulmonary surgery (P = 0.03) and the right - side of the pneumonectomy (P < 0.001). The indication of the pneumonectomy was retained neither by the univariate analysis, nor by the logistic regression significant risk factors.


CONCLUSIONS
The predictive factors of a bronchial fistula after a pneumonectomy are dominated by respiratory co-morbidities. To prevent this complication, we insist on the stop of the tobacco, a better respiratory preparation and the acquisition of a protocol adapted of the bronchial stub after a pneumonectomy particularly on the right side.
Yena
S
S
Service de chirurgie générale et thoracique, CHU du Point G, BP 2368, Bamako, Mali. sadioy@hotmail.com
Doddoli
C
C
Doumbia
S
S
D'journo
X B
XB
Aragon
A
A
Mondini
M
M
Marghli
A
A
Thomas
P
P
Giudicelli
R
R
Sangare
D
D
Soumare
S
S
Fuentes
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000209:etiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012744:Sex Ratio; D012907:Smoking / Q000009:adverse effects*