摘要
目的总结普胸外科术后胸腔出血的原因及二次开胸止血的方法及效果,以减少该并发症的发生率。方法回顾性分析我院19例普胸手术后二次开胸止血患者的病例资料。行肺大泡切除术5例,肺癌根治术7例,纵隔肿瘤切除术1例,食管肿瘤切除术4例,肋骨骨折内固定术2例,术后均发生胸腔出血。在积极抗休克治疗的同时,沿原手术切口行二次开胸止血治疗。剥离面出血9例,行电灼止血及可吸收止血材料覆盖创面;胸膜顶静脉出血5例,肋间动脉出血3例,支气管动脉出血1例,行缝扎止血并用可吸收止血材料覆盖缝扎处;肺静脉结扎线滑脱致肺静脉残端出血1例,遂行压迫止血、缝扎残端等方法止血。结果出血量800～1 000 ml者9例,1 000～2 000 ml者7例,2 000 ml以上者2例,大出血、失血性休克死亡1例。二次开胸止血手术时间平均2.8（2.2～3.5）h。18例患者手术止血效果确切,术后无活动性出血,切口愈合良好;1例右下肺癌根治术患者二次开胸后发现为结扎线脱落所致肺静脉残端出血,虽经压迫止血及缝扎止血后残端无活动性出血,但最终仍因失血性休克无法纠正而死亡。结论普胸外科术后胸腔出血,重在预防;如有二次开胸指征,应及时果断开胸止血。
Objective To summarize the therapy and effect of open reoperation of hemostasis for postoper- ative hemorrhage associated with thoracic surgical procedures, and to reduce the incidence of postoperative hemor- rhage. Methods A total of 19 patients with postoperative hemorrhage associated with thoracic surgical proce- dures performed open reoperation of hemostasis were analyzed retrospectively. The primary thoracic surgery was pulmonary bulla resection in 5 cases, pulmonary lobectomy in 7 cases, mediastinal tumor excision in 1 case, ex- ophageal neoplasms resection in 4 cases and internal fixation of rib fractures in 2 cases. All 19 cases were treated by active anti-shock treatment and open reoperations via the incision of the primary surgery. Among them, 9 cases were found hemorrhage in dissection surface and treated by electric coagulation and covering the wound surface with absorbable hemostasis stuff. 5 cases were hleborrhagia of cupula of pleura, 3 cases were inter-costal an- giorhagia, 1 case was bronchia arterial hemorrhage. All of them were performed transfixion and covering the wound with absorbable hemostasis stuff. One case was stump hemorrhage due to ligature detachment of pulmo- nary vein, and was carried out the compression hemostasis and transfixion. Results The bleeding amount was 800 to 1000 ml in 9 cases, 1000 to 2000 ml in 7 cases and 2000 ml above in 2 cases. The reoperation time was 2.2 to 3.5 hours with an average of 2.8 hours. 18 cases were achieved bleeding cease and the wound healed well. One case with stump hemorrhage due to ligature detachment of pulmonary vein was died of hemorrhagic shock. Conclusions Prevention is important for avoiding postoperative hemorrhage of thoracic surgical procedures. Reoper- ation of hemostasis would be performed promptly when the open thoracic reoperation indication appeared.
出处
《中国现代手术学杂志》
2014年第6期457-459,共3页
Chinese Journal of Modern Operative Surgery
关键词
手术后出血
止血
手术
再手术
胸外科手术
postoperative hemorrhage
hemostasis, surgical
reoperation
thoracic surgical procedures
