肺手术后并发症的再开胸处理  

Rethoracotomy for complications after lung surgery

作　　者：梁朝阳[1] 寿延宁[1] 张海涛[1] 郭永庆[1] 石彬[1] 田燕雏[1] 宋之乙[1] 

机构地区：[1]中日友好医院胸外科,北京100029

出　　处：《中日友好医院学报》2002年第5期274-278,共5页Journal of China-Japan Friendship Hospital

摘　　要：目的 :探讨肺手术后需再开胸处理的并发症的种类、发生率以及相关风险致病因素。方法 :回顾分析 17a来各种肺手术后需再开胸处理的并发症 ,并对主要并发症的发生率、死亡率、致病因素、与病种及手术方式的关系和再开胸手术的指征进行统计学分析。结果 :1984年 11月～ 2 0 0 2年 4月 ,共完成各种肺手术 1847例 ,其中 2 0例 (1.0 8% )因各种并发症需要再次开胸手术处理。最常见的再开胸原因为 :术后出血 8例 ,瘘 5例 (支气管胸膜瘘 3例 ,肺断面瘘晚期开胸处理脓胸 2例 )。主要出血部位在纵隔及气管、支气管血管 3例 ,肋间血管 2例 ,肺血管 2例 ,另外 1例未能探查出明确出血部位。 2 0例患者中死亡 3例 ,其中因瘘行再开胸术死亡 2例 ,因出血 1例。结论 :肺手术后需要再开胸处理的并发症比率较低 ,最常见为出血 ,死亡率最高的是瘘。此类并发症应以预防为主 ,减少各种致病因素。一旦发生 ,尽快明确诊断并治疗 。Objective:To explore the type,morbidity and risk factors of postoperative complication following lung surgery which require rethoracotomy.Methods:The data on rethoracotomies after lung surgery over the past 17 years in our department were retrospectively reviewed. The morbidity, mortality, various risk factors of major complications,the relationship between complications with species of disease and type of operation and the indication of rethoracotomy were analyzed.Results:From November 1984 to April 2002, 1847 patients underwent primary thoracotomies for various kinds of lung diseases. Among these,20 (1.08%) patients required rethoracotomy for various postoperative complications..The most common indication for rethoracomoty was hemorrhage which occured in 8 patients. The source of bleeding were mediastinal and bronchial blood vessel(3 patients)and intercostal blood vessel (2 patients). Two patients had to reoperated because of hemorrhage from a major vessel of the lung. In 1 case the postoperative hemothorax occurred without evident surgical origin. Further indications for rethoracotomy were bronchopleural fistula in 3 patients and persistent parenchymal leak in 2 patients. There were 5 additional causes distributed among the other 7 patients. The overall mortality rate was 15%(3/20), with the highest (40%) among fistula patients.Conclusion:Postoperative complication following lung surgery which require rethoracotomy are rare. The most common complication is bleeding.The highest mortality rate is from fistula.Our experience shows that for this kind of complications,it is more important to reduce the risk factors in prevention. The indication for rethoracotomy should be done as early as possible to avoid late serious complications.

关 键 词：肺手术 再开胸 并发症 

分 类 号：R655.3[医药卫生—外科学] R619[医药卫生—临床医学]