胸外科术后30d内非计划二次手术的临床特点  

Clinical Characteristics of 30-day Unplanned Reoperations after Thoracic Surgery

作　　者：张家齐[1] 刘磊[1] 赵珂 郭超[1] 黄诚[1] 陈野野[1] 刘洪生[1] 李单青 ZHANG Jiaqi;LIU Lei;ZHAO Ke;GUO Chao;HUANG Cheng;CHEN Yeye;LIU Hongsheng;LI Shanqing(Department of Thoracic Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院胸外科,北京100730

出　　处：《中国医学科学院学报》2022年第5期809-814,共6页Acta Academiae Medicinae Sinicae

基　　金：国家重点研发计划(2020YFB1313700)。

摘　　要：目的分析胸外科术后30 d内非计划二次手术患者的临床特点。方法回顾性分析2016年5月至2021年5月北京协和医院胸外科术后30 d内非计划二次手术患者的临床资料。结果术后30 d内非计划二次手术发生率为0.75%(79/10543);非计划二次手术患者中位住院天数19(12,37)d,中位住院费用109929.11(80549.46,173491.87)元;22例(27.85%)患者接受输血治疗,26例(32.91%)患者接受重症监护治疗;2016年5月至2017年5月发生非计划二次手术例数最多。出血(21.52%)、乳糜胸(17.72%)、肺漏气(16.46%)、肺不张(13.92%)及消化道瘘(11.39%)为胸外科非计划二次手术的主要原因。其中,非食管/贲门组患者非计划二次手术原因主要为出血、肺漏气、肺不张及乳糜胸;食管/贲门组患者非计划二次手术原因主要为消化道瘘、切口感染愈合不良、出血及乳糜胸。非计划二次手术患者中,4例死亡,17例好转,58例痊愈。结论胸外科非计划二次手术患者住院时间长,住院费用高。出血、乳糜胸、肺漏气、肺不张及消化道瘘是非计划二次手术的主要原因。Objective To investigate the clinical characteristics of 30-day unplanned reoperations after thoracic surgery.Methods We retrospectively analyzed the clinical data of patients with unplanned reoperations within 30 days after thoracic surgery in Peking Union Medical College Hospital from May 2016 to May 2021.Results The 30-day unplanned reoperations showed the incidence of 0.75%(79/10543),the median hospital stay of 19(12,37)days,and the median hospitalization cost of 109929.11(80549.46,173491.87)yuan.Twenty-two(27.85%)patients received blood transfusion and 26(32.91%)underwent intensive care.The period between May 2016 and May 2017 witnessed the most unplanned reoperations.The main causes of unplanned reoperations after thoracic surgery were bleeding(21.52%),chylothorax(17.72%),pulmonary air leakage(16.46%),atelectasis(13.92%),and gastroesophageal fistula(11.39%).Specifically,the main causes of unplanned reoperations in the patients of non-esophagus/cardia group were bleeding,pulmonary air leakage,atelectasis,and chylothorax,and those in the patients of esophagus/cardia group were gastroesophageal fistula,incision infection and poor healing,bleeding,and chylothorax.Among all the patients with unplanned reoperations,4 patients died,17 improved,and 58 recovered.Conclusions The patients who underwent unplanned reoperations after thoracic surgery had a long hospital stay and high hospitalization costs.Bleeding,chylothorax,pulmonary air leakage,atelectasis,and gastroesophageal fistula were the main reasons for the unplanned reoperations.

关 键 词：胸外科手术 非计划二次手术 临床特点 

分 类 号：R6[医药卫生—外科学] R655[医药卫生—临床医学]