大咯血的急诊外科治疗

Urgent surgical management of massive hemoptysis

目的 总结 4 4a急诊手术治疗大咯血经验。方法 回顾性研究 195 8～ 2 0 0 1年在本院急诊手术的 89例大咯血患者 ,收集临床表现、诊断方法、原发病因、治疗和结果等相关资料。结果 85 4 %病例的X线表现与出血部位一致 ,其它诊断方法 (支气管镜、CT、血管造影术等 )作为重要补充。由于 1982年后的早期外科干预 ,术前咯血总量、咯血平均量和低血压、休克发生比例较前明显减少 ,术后并发症从 1982年前的 2 2 2 %降至 17 1% ,围手术期死亡率从 9 3%降至 0。急诊全肺切除术并发症 ( 2 3 3% )高于肺叶切除术 ( 15 2 % )。在过去 4 4a肺结核一直是大咯血的主要原发病因。结论 符合新的外科治疗标准的患者应及早手术 ;选择切除范围要保守 。

Objective To summarize 44-year experience of emergency surgery of massive hemoptysis Methods 89 patients with life-threatening hemoptysis who underwent emergency operations from 1958 to 2001 in our hospital were studied retrospectively and data were collected for the clinical manifestations,diagnostic techniques,underlying cause,treatment and outcome Results The radiographic findings in 85 4% cases were consistent with the bleeding origin,and other diagnostic techniques(bronchoscopy,CT,angiography and so on)were used as important complements Owing to early surgical intervention after 1982,the rates of post-operative complications decreased from 22 2% to 17 1%(P=0 16),the perioperative mortality from 9 3% to 0 Emergency pneumonectomy(23 3%)had more complications than lobectomy(15 2%) Tuberculosis remained the main underlying etiology of massive hemoptysis overwhelmingly during the past 44 years Conclusion The eligible patients fit with new criterion for surgery should be operated as early as possible;the scope of resection should be chosen conservatively and a lobectomy preferred