背景与目的 大咯血是肺癌术后少见但严重的并发症.本研究旨在探讨致死性大咯血的发生机制、危险因素、先兆症状及预防和治疗措施.方法 2007年4月-2011年5月四川大学华西医院共行肺癌手术1,737例,围手术期死亡20例,其中死于大咯血7例,复习7例患者的临床资料并结合文献进行分析.结果大咯血是肺癌术后第2位死亡原因.7例中6例直接死于大咯血,1例因大咯血行二次手术,最终死于肺部感染、呼吸衰竭.4例发生过先兆出血症状.4年大咯血发生率为0.4％( 7/1,737).结论 支气管胸膜瘘引起的支气管血管瘘是大咯血发生的机制,糖尿病为高危因素,早期诊断、早期外科治疗支气管胸膜瘘或支气管血管瘘可避免大咯血死亡的发生.%Background and objective Massive hemoptysis was a rare but severe postoperative complication of lung cancer. The aim of the present study is to investigate the mechanisms, risk factors, early symptoms, prevention, and treatment options for fatal hemoptysis. Methods From April 2007 to May 2011, 1,737 patients with lung cancer were surgically treated in the West China Hospital of Sichuan University. Twenty patients died during the perioperative period, seven of whom died of massive hemoptysis. These seven cases were analyzed, and their clinical data, as well as related literatures, were reviewed. Results Massive hemoptysis is the second cause of death after lung cancer surgery. Six patients died directly of massive hemoptysis. One patient underwent secondary surgery because of massive hemoptysis, but eventually died because of lung infection and respiratory failure. Early symptoms of hemorrhage were observed in four cases, and the overall incidence rate of massive hemoptysis was 0.4% (7/1,737). Conclusion Bronchovascular fistula (BVF) caused by bronchopleural fistula (BPF) is the mechanism for massive hemoptysis. Diabetes is a high risk factor. Early diagnosis and surgical treatment of BPF or BVF can prevent the occurrence of death as a result of massive hemoptysis.
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