咯血患者外科手术治疗体会

Experience of surgical treatment of hemoptysis

目的 探讨咯血患者外科手术治疗的体会。方法 选取2018年1月至2022年6月在河南省胸科医院行外科手术治疗的咯血患者78例为研究对象,对其临床资料进行回顾性的总结分析。结果 所有患者中42例行胸腔镜微创手术,其中6例因胸腔粘连严重而中转开胸手术,36例行传统前外侧切口开胸手术,具体术式包括:肺叶切除术53例,肺叶联合肺段切除术11例,肺楔形切除术6例,肺叶联合肺楔形切除术3例,左侧全肺切除术4例,肺袖状切除1例。围术期无死亡病例;69例术后恢复顺利,占比88%;6例患者术后出现并发症,占比8%。术后随访至今,随访率为87%(68/78)。术后有4例患者复发咯血,均为少量咯血,其中2例为肿瘤复发进展引起咯血,1例为支气管残端炎引起咯血复发,1例考虑合并真菌感染引起咯血。结论 对于咯血患者,目前外科手术治疗仍是最直接并且安全有效的方法,充分的术前准备,病变部位及出血部分的精确定位及手术适应证的个体化把握,对决定手术方式和手术疗效至关重要。

Objective To investigate the experience of surgical treatment of hemoptysis.Methods Seventy-eight patients with hemoptysis who underwent surgical treatment at Henan Chest Hospital from January 2018 to June 2022 were selected as the research subjects.The clinical data were analyzed retrospectively.Results Among all of the patients,42 patients underwent thoracoscopic minimally invasive surgery,of which 6 patients underwent thoracotomy due to severe thoracic adhesions,and 36 patients underwent traditional anterolateral thoracotomy.The specific operation methods including:lobectomy in 53 cases,lobectomy combined with segmental lobectomy in 11 cases,pulmonary wedge resection in 6 cases,lobectomy combined with pulmonary wedge resection in 3 cases,left pneumonectomy in 4 cases,sleeve resection in 1 case.There was no perioperative death;69 patients recovered smoothly after surgery,accounting for 88%;6 patients had postoperative complications,accounting for 8%.The follow-up rate to date was 87%(68/78).Four patients experienced recurrent hemoptysis after operation,all of which were small,amounts.Among them,2 patients experienced tumor recurrence and progression,1 patient experienced recurrent hemoptysis due to bronchial stump inflammation,and 1 patient was considered to have combined fungal infection to cause hemoptysis.Conclusionss Surgical treatment is the most direct and reliable method for hemoptysis patients.Adequate preoperative preparation,accurate localization of the lesion and the bleeding part and individualized control of the operative indication are very important to determine the operative method and curative effect.