胸外科术后严重并发症的临床特点及诊治——单中心10年结果  

Clinical characteristics and treatment experience of severe complications after thoracic surgery——ten-year outcome from a single center

作　　者：许哲 张鑫[1] 许顺[1] XU Zhe;ZHANG Xin;XU Shun(Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang, 110001, P.R.China)

机构地区：[1]中国医科大学附属第一医院胸外科

出　　处：《中国胸心血管外科临床杂志》2019年第9期858-864,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：辽宁省科技厅基金项目(2017225035)

摘　　要：目的探讨胸外科术后严重并发症的临床特点,并对诊治方法进行总结。方法回顾性分析 2008 年 1 月至 2018 年9 月在我院胸外科接受手术治疗的 15 213 例患者的临床资料。其中 36 例(0.24%)患者因术后并发症死亡。排除不合格病例(n=39)后,根据是否存在肺部感染及其他 13 类术后并发症,将患者分成并发症组[n=389,男 294 例、女 95 例,年龄(61.93±10.23)岁]与非并发症组[n=14 785,男 8 636 例、女 6 149 例,年龄(55.27±13.21)岁]。对两组患者的年龄、性别、诊断、手术方式、术后住院时间、住院费用等临床资料进行分析。并对并发症组患者的治疗方案及转归进行了总结。结果并发症组在年龄、男性占比、恶性肿瘤占比、食管疾病占比、术后住院时间及住院费用上显著高于非并发症组(P<0.05)。在院死亡的手术患者中前 3 位死因分别为肺栓塞(25.00%)、肺部感染(16.67%)及急性呼吸衰竭(16.67%)。严重并发症组中前 5 位依次为肺部感染(24.73%)、胸腔感染(19.83%)、食管吻合口瘘(17.48%)、肺不张(11.51%)及肺栓塞(6.18%)。结论胸外科医生应根据手术患者的临床特点及时识别可能出现术后严重并发症的高危患者,并及时采取多学科综合诊治术后并发症。Objective To discuss the clinical characteristics and the management of major complications after thoracic surgery. Methods Retrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27± 13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized. Results The age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%). Conclusion Thoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.

关 键 词：胸外科手术 外科手术 手术后并发症 

分 类 号：R655[医药卫生—外科学]