胸部良性疾病非计划性二次手术临床分析与探讨

Clinical analysis of unplanned reoperation in the surgical treatment of benign thoracic disease

目的：探讨胸部良性疾病非计划二次手术的原因，降低非计划二次手术率，研究防止措施。方法回顾性分析2006年5月—2016年5月间胸部良性疾病患者行外科手术治疗的临床资料574例，其中16例术后因各种原因行非计划二次手术，总结胸部良性疾病外科治疗后非计划二次手术的临床特点、治疗经过及原因，对可能的影响因素进行单因素分析和多因素分析。结果本组患者行非计划二次手术，无死亡病例，二次手术手术时间为30-215（135.6±47.4）min。术中出血量50-650（313.6±93.1）mL。术后住院时间7-30（15.7±6.8）d。二次手术原因包括术后出血（10例）、术后肺持续漏气（4例）、切口感染（2例）。单因素分析首次手术疾病分类，首次手术时间，首次手术方式与胸部良性疾病非计划二次手术相关性有统计学意义（P＜0.05），多因素分析结果显示首次手术疾病分类，首次手术时间，首次手术方式是胸部良性疾病非计划二次手术的独立危险因素（P＜0.05）。结论根据胸部良性疾病的不同疾病类别来估计和预防可能出现的并发症，特别是胸部炎症性病变，术前充分准备、术中仔细操作、术后并发症的早期积极处理，能降低胸部良性疾病非计划二次手术的发生率。

Objective To investigate the causes of benign thoracic disease unplanned reoperation,improve the level of diagnosis and treatment and reduce the rate of unplanned reoperation. Methods From May 2006 to May 2016,594 cases of benign thoracic disease were performed thoracic surgery,including 16 patients underwent the unplanned reoperation due to various reasons. The clinical characteristics,therapy course and results of benign thoracic disease unplanned reoperation were analyzed retrospectively. Results The patients underwent the unplanned reoperation were no deaths. The operative time 30-215 （135.6 ±47.4） min,intraoperative blood loss 50 -650 （313.6 ±93.1 ） mL,postoperation hospitalization duration 7 -30 （15.7 ±6.8）d. The causes of benign thoracic disease unplanned reoperation were as follows：postoperative bleeding （10 cases）,prolonged air leaks （4 cases）,incision infection （2 cases）. Univariate analysis showed first-time classification of disea-ses,operative time and operation method were statistically significant （P〈0.05 ）,Multivariate Logistic regression analysis revealed first-time classification of diseases,operative time and operation method were independent factors associated with benign thoracic disease unplanned reoperation. Conclusion According to the different classification of benign thoracic disease to estimate and prevent possible complications,we need to have sufficient preoperative preparation,intraoperative careful operation.Early active processing can be taken in postoperative complications.It can reduce the incidence of unplanned reoperation in benign thoracic disease,especially the chest inflammatory diseases.