手术切除肺部治疗严重咯血。

Surgical lung resection for severe hemoptysis.

作者信息

Andréjak Claire, Parrot Antoine, Bazelly Bernard, Ancel Pierre Yves, Djibré Michel, Khalil Antoine, Grunenwald Dominique, Fartoukh Muriel

机构信息

Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

Ann Thorac Surg. 2009 Nov;88(5):1556-65. doi: 10.1016/j.athoracsur.2009.06.011.

DOI:10.1016/j.athoracsur.2009.06.011

PMID:19853112

Abstract

BACKGROUND

The role of surgical lung resection in the management of severe hemoptysis has evolved after advances in interventional radiology. We sought to describe the indications for surgical lung resection in such patients and to identify predictive factors of postoperative complications.

METHODS

This study is a retrospective analysis (May 1995 to July 2006) of consecutive patients referred to the intensive care unit of a tertiary hospital for severe hemoptysis who underwent surgical lung resection.

RESULTS

Among 813 patients referred for severe hemoptysis, 111 underwent surgical lung resection. Interventional radiology had been first attempted in 87 patients (78%); 68 underwent surgery because of a failed procedure (n = 28) or bleeding persistence or recurrence within 72 hours despite a completed procedure (n = 40); 19 patients underwent surgery after bleeding control. The remaining 24 patients (22%) were directly referred to the surgeon (5 for emergency surgery). Overall, surgery was performed in emergency (n = 48), scheduled after bleeding control (n = 48), or planned after discharge (n = 15). The main indications for surgery were mycetoma, cancer, bronchiectasis, and active tuberculosis. Surgery for mycetoma (odds ratio, 9.4; 95% confidence interval, 2.8 to 32), emergency surgery (odds ratio, 5.3; 95% confidence interval, 1.8 to 16), and pneumonectomy (odds ratio, 4.7; 95% confidence interval, 1.2 to 18) independently predicted complications. Fifteen patients died in the intensive care unit, of whom 14 underwent emergency surgery. Chronic alcoholism (odds ratio, 4.6; 95% confidence interval, 1.1 to 19), the need for mechanical ventilation or vasoactive drugs on admission (odds ratio, 8.2; 95% confidence interval, 1.9 to 35), and blood transfusion before surgery (odds ratio, 8; 95% confidence interval, 1.5 to 42) predicted mortality.

CONCLUSIONS

Attempting at controlling bleeding with first-line nonsurgical approaches appears necessary to optimize the operative conditions and improve outcome of patients with severe hemoptysis.

摘要

背景

随着介入放射学的进展，外科肺切除在严重咯血治疗中的作用已经发生了演变。我们试图描述此类患者外科肺切除的适应证，并确定术后并发症的预测因素。

方法

本研究是一项回顾性分析（1995年5月至2006年7月），纳入了因严重咯血被转诊至一家三级医院重症监护病房并接受外科肺切除的连续患者。

结果

在813例因严重咯血被转诊的患者中，111例接受了外科肺切除。87例患者（78%）首先尝试了介入放射学治疗；68例患者因治疗失败（n = 28）或尽管治疗完成但在72小时内出血持续或复发（n = 40）而接受手术；19例患者在出血得到控制后接受手术。其余24例患者（22%）直接被转诊给外科医生（5例接受急诊手术）。总体而言，手术在急诊情况下进行（n = 48），在出血控制后安排（n = 48），或在出院后计划进行（n = 15）。手术的主要适应证为曲菌球、癌症、支气管扩张和活动性肺结核。曲菌球手术（比值比，9.4；95%置信区间，2.8至32）、急诊手术（比值比，5.3；95%置信区间，1.8至16）和肺切除术（比值比，4.7；95%置信区间，1.2至18）独立预测并发症。15例患者在重症监护病房死亡，其中14例接受了急诊手术。慢性酒精中毒（比值比，4.6；95%置信区间，1.1至19）、入院时需要机械通气或血管活性药物（比值比，8.2；95%置信区间，1.9至35）以及手术前输血（比值比，8；95%置信区间，1.5至42）预测死亡率。