普胸术后再次剖胸止血11例临床分析

摘要

目的：总结普胸术后胸腔内大出血再次剖胸止血的临床资料，以便更好地预防和处理普胸术后胸腔内大出血。方法：对我院近5年普胸外科术后胸腔大出血并行再次剖胸止血的病例资料进行分析，寻找出血原因并总结治疗经验。结果：共11例普胸术后再次剖胸止血，痊愈10例，死亡1例，出血部位有切口肋间血管出血3例，壁层与纵隔胸膜广泛渗血1例，右下肺动脉干结扎线脱落1例，肋骨断端出血1例，支气管动脉出血1例，下肺韧带出血1例，食管床出血1例，纵隔手术创面出血1例，未能找到明确出血点1例。结论：关胸前仔细检查，严密止血是预防术后胸腔大出血的重要措施。及时果断地再次剖胸止血是治疗术后胸腔大出血的关键。%Objective:To summarize the clinical data in patients with postoperative haemothorax following conventional thoracic surgery for prevention of such incidence and approaches to management of the events.Methods:The clinical data were retrospectively examined in 11 patients required re-operation to manage the postoperative haemothorax in the past 5 years,with analysis of the causes and summary of the treatment experience .Results:Of total 11 pa-tients required second operation to manage the postoperative haemothorax,10 were successfully managed,and 1 died.The hemorrhage occurred at incision of intercostal vessels in 3,and extensive bleeding occurred in between the chest wall and mediastinal pleura in 1.One case of hemorrhage was due to dislo-cation of the ligation of the right inferior pulmonary artery,and the remaining were associated with bleeding site of rib stump(1 cases),bronchial artery bleeding(1 cases),pulmonary ligament(1 case),esophageal bed(1 case),and mediastinum operation(1 case).Another one case failed to be identified for bleeding site.Conclusion: In conventional thoracic surgery,careful confirmation and effective hemostasis may prevent the incidence of postoperative heamothorax.Should there be such events,re-operation shall be performed immediately in order to stop the bleeding .