运用电视胸腔镜止血治疗普胸术后胸腔内再出血  

Video-Assisted Thoracoscopic Hemostasis for Rebleeding after General Thoracic Surgery

作　　者：汤中文[1] 倪正义 

机构地区：[1]武汉市医疗救治中心胸外科,武汉430023

出　　处：《实用临床医学（江西）》2017年第9期33-35,共3页Practical Clinical Medicine

摘　　要：目的探讨运用电视胸腔镜止血治疗普胸术后胸腔内再出血的可行性及疗效。方法回顾11例普胸术后胸腔内再出血采取电视胸腔镜止血患者的临床资料,对出血部位、止血方式、效果及并发症进行分析,并评价其可行性及疗效。结果二次手术间隔为术后3~25h。均找到出血部位,其中胸壁粘连剥离面出血4例,下肺韧带内出血2例,开胸术切口肌肉及肋骨创面渗血1例,采取电凝或缝扎止血;肺创面渗血2例,采取缝合肺创面止血;支气管动脉及肺动脉残端出血各1例,采取缝扎止血;静脉残端出血1例,采取胸腔镜辅助小切口缝扎止血。均成功止血,术后1例呼吸机辅助16h后脱机,2例出现肺复张不佳,1例出现术后肺部感染,经对症治疗均痊愈出院。结论运用电视胸腔镜止血治疗普胸术后胸腔内再出血安全可靠。Objective To explore the feasibility and efficacy of video-assisted thoracoscopic hemostasis in the treatment of rebleeding after general thoracic surgery.Methods Clinical data of11 patients who underwent video-assisted thoracoscopic hemostasis for rebleeding after thoracotomy were analyzed retrospectively.The bleeding sites,hemostatic methods,efficacies and complications were analyzed to evaluate the feasibility and efficacy of video-assisted thoracoscopic hemostasis.Results The second operation was performed 3-25 hours after thoracotomy.Bleeding sites were found and successful hemostasis was achieved in all the 11 patients.Among them,electrocoagulation or hemostatic suture was performed in 7 patients,including 4 patients with bleeding from the dissected surface of chest wall adhesion,2 patients with bleeding in the inferior pulmonary ligament,and 1 patient with bleeding from muscle incision and rib wound;Lung wounds were sutured in 2 patients with pulmonary wound bleeding;Hemostatic suture was performed in 1 patient with bronchial artery bleeding and 1 patient with pulmonary artery stump bleeding;Thoracoscopic-assisted suture was performed in 1 patient with venous stump bleeding.After operation,1 patient was weaned from mechanical ventilation after 16 hours,2 patients had insufficient pulmonary reexpansion,and 1 patient had pulmonary infection.All these patients were cured and discharged after symptomatic treatment.Conclusion Video-assisted thoracoscopic hemostasis is safe and reliable for treating rebleeding after general thoracic surgery.

关 键 词：电视胸腔镜 普胸手术 术后出血 止血 

分 类 号：R65[医药卫生—外科学]