VATS肺叶切除术中血管损伤出血影响因素研究  

Investigation of Influencing Factors for Vascular Injury and Bleeding during VATS Lobectomy

作　　者：潘永东 袁国华 PAN Yongdong;YUAN Guohua(Department of Thoracic and Cardiovascular Surgery,Yichun People's Hospital,Yichun 336000,China)

机构地区：[1]宜春市人民医院胸心血管外科,江西宜春336000 [2]万安县中医院外科,江西万安343800

出　　处：《中国医学创新》2024年第15期148-153,共6页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(202312206)。

摘　　要：目的:探讨电视经辅助胸腔镜手术(video-assisted thoracic surgery,VATS)肺叶切除术中血管损伤出血的影响因素,为手术预防及策略提供参考依据。方法:本研究对2022年1月—2023年10月收集的宜春市人民医院100例行VATS手术患者进行回顾性分析,根据术中是否出血,将患者分为出血组(9例)和未出血组(91例)。对两组患者的临床资料进行单因素分析,再将分析后有统计学意义的因素进行多因素回归分析;并用统计软件绘制受试者操作特征(receiver operating characteristic,ROC)曲线。结果:单因素分析显示,出血组血红蛋白(Hb)、血小板计数(PLT)、总胆固醇(CHOL)、误伤肺动脉分支,肺动、静脉壁薄,病理性粘连或炎症,血管的解剖变异,手术器械使用不当与未出血组比较,差异均有统计学意义(P<0.05)。多因素回归分析显示,Hb,PLT,CHOL,误伤肺动脉分支,肺动、静脉壁薄,病理性粘连或炎症,血管的解剖变异,手术器械使用不当是VATS手术术中血管损伤出血的影响因素(P<0.05)。结论:VATS术中肺动脉分支误伤、血管壁薄、病理性粘连或炎症、血管的解剖变异、手术器械使用不当与血管损伤出血有关。认识并预防这些风险因素,能够显著降低术中出血的发生率,提高手术的安全性。Objective:To explore the influencing factors for vascular injury and bleeding during video-assisted thoracic surgery(VATS)lobectomy,thereby providing evidence to inform surgical prevention strategies and tactics.Method:A retrospective analysis was conducted on 100 patients who underwent VATS at Yichun People's Hospital between January 2022 and October 2023,patients were divided into a bleeding group(n=9)and a non-bleeding group(n=91)based on intraoperative bleeding occurrences.Univariate analyses were performed on the clinical data of both groups of patients,statistically significant factors were subjected to multivariate regression analysis;receiver operating characteristic(ROC)curves was generated using statistical software.Result:Univariate analysis showed that the bleeding group had statistically significant differences compared to the non-bleeding group in terms of hemoglobin(Hb),platelet count(PLT),total cholesterol(CHOL),inadvertent injury to pulmonary artery branches,thin pulmonary artery and vein walls,pathological adhesions or inflammation,vascular anatomical variations and improper use of surgical instruments(P<0.05).Multivariate regression analysis revealed that Hb,PLT,CHOL,thin pulmonary artery and vein walls,pathological adhesions or inflammation,vascular anatomical variations and improper use of surgical instruments were influencing factors for vascular injury and bleeding during VATS(P<0.05).Conclusion:In VATS,inadvertent injury to pulmonary artery branches,thin vascular walls,pathological adhesions,inflammation,vascular anatomical variations and improper use of surgical instruments are associated with vascular injury and bleeding.Recognizing and preventing these risk factors can significantly reduce the incidence of intraoperative bleeding and enhance surgical safety.

关 键 词：心胸外科 胸腔镜手术 血管损伤 出血风险 

分 类 号：R734.2[医药卫生—肿瘤]