普胸术后出血再次剖胸止血10例分析

ANALYSIS OF 10 PATIENTS REOPERATED FOR THORACIC CAVITY BLEEDING AFTER RESECTION EXPERIENCE

目的 :探讨普胸术后血胸的原因及处理办法。方法 :对自 1976年～ 2 0 0 0年手术治疗普胸术后血胸 10例病人的出血部位、出血原因及诊治经过进行回顾性分析。结果 :肋骨断端及肋血管损伤处出血 5例、支气管动脉出血 2例、肿瘤浸润胸壁处出血 1例、胸腔多处渗血 1例、未见明显出血 1例。采用损伤血管缝扎 ,肋骨断端烧灼及骨蜡填塞 ,肋骨固定 ,止血胶及止血纤维贴敷胸壁渗血面等方法止血 ,同时清理胸内凝血块。剖胸止血术后均未再次出现胸内活动性出血。结论 :普胸手术要预防血胸的发生 ,术中必须认真操作、仔细检查 ,特别应注意肋骨断端、支气管残端周围、壁层胸膜肿瘤浸润破损。

Objective:To study the cause and prophylactic and therapeatic measures of intrathoracic bleeding after resection of chest tumor.Methods:Ten patients reoperated for intrathorecic bleeding after resection of thoracic tumor during 1976～2000 were reviewed.Results:The broken enos of fractured boneing of ribbing and blood vessel intercostales hemorrhaged in 5,bronchial arteria in 2,chest wall infiltrated with tumor in 2,excessive intrathoracic angiorrhea in 1,no evidently bleeding in 1.The hemostatic methods were oversewing and lighting fractured blood vessels,electrocoagulating and packing with bone wax osteorrhagia of rib fracture,reduction of fracture,adhibitting absorbable gelatin sponge or colloid on chest wall of oozing of blood,scavenging intrathoracic clot at the same time.The intrathoracic active hemorrhage had stopped after thoracic reoperation.Conclusions:To prevent hemothorax,the thoracic operations should be performed strictly according to the standard operation technique rules.To find intrathoracic hemorrhage,the thoracic cavity should be inspected conscientiously in fractured ribbing,bronchial stump,chest wall infiltrated with tumor and surface of clearance of lymph nodes especially.