Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China.
Surg Endosc. 2013 Feb;27(2):530-7. doi: 10.1007/s00464-012-2475-1. Epub 2012 Jul 18.
Massive bleeding caused by vascular injury is considered the most troublesome and dangerous complication during video-assisted thoracoscopic surgery (VATS) pulmonary resection and is an important reason for emergency conversion to thoracotomy. The purpose of this paper was to show the suction-compressing angiorrhaphy technique (SCAT) for troubleshooting this problem without conversion.
A total of 414 consecutive VATS anatomic pulmonary resections were performed between May 2006 and July 2011, among which 17 operations (4.11 %) encountered unexpected vascular injury. The procedure for troubleshooting vascular injury included bleeding control and angiorrhaphy. Bleeding was first controlled through side compression of the injured site with an endoscopic suction. Angiorrhaphy was then performed with running 5-0 Prolene suture using different procedures according to the size and location of the injuries, including direct suture upon suction compression, suture after substituting suction compression with clamping of the injured site, or suture after attaining proximal cross-clamping of the main pulmonary artery. Detailed information of these patients was carefully reviewed. The reasons for conversion to thoracotomy also were revealed.
Fifteen cases (15/17, 88.24 %) were successfully managed without conversion. Two cases of left main pulmonary artery injury were converted to thoracotomy due to difficulties in proximal cross-clamping of the injured vessel. Blood loss of the 17 patients ranged from 60-935 (median, 350) ml. Two patients were administered with allogeneic blood. The postoperative chest CT scan showed normal blood flow on the injured vessels. The total conversion rate was 2.66 % (11/414). The most common reason for conversion was hilar lymphadenopathy.
The SCAT is an effective procedure for managing vascular injury during VATS anatomic pulmonary resection. In most cases, bleeding control and angiorrhaphy could be achieved using this method with acceptable blood loss, thereby avoiding emergency conversion to thoracotomy.
在电视辅助胸腔镜手术（VATS）肺切除术中，血管损伤引起的大出血被认为是最麻烦和最危险的并发症，也是紧急转为开胸手术的重要原因。本文旨在介绍一种无需转为开胸手术即可解决该问题的吸引压迫血管吻合术（SCAT）。
2006 年 5 月至 2011 年 7 月，共进行了 414 例连续的 VATS 解剖性肺切除术，其中 17 例（4.11%）术中发生意外血管损伤。处理血管损伤的程序包括止血和血管吻合。首先通过内镜吸引器对损伤部位进行侧压以控制出血，然后根据损伤的大小和位置，采用不同的方法进行连续 5-0 Prolene 缝线缝合，包括在吸引压迫下直接缝合、用夹闭损伤部位替代吸引压迫后缝合、或在主肺动脉近端阻断后缝合。仔细回顾了这些患者的详细信息，并揭示了转为开胸手术的原因。
17 例患者中有 15 例（15/17，88.24%）无需转为开胸手术即成功处理。2 例左主肺动脉损伤因难以近端阻断损伤血管而转为开胸手术。17 例患者的出血量为 60-935（中位数，350）ml，其中 2 例患者输注异体血。术后胸部 CT 扫描显示损伤血管血流正常。总转化率为 2.66%（11/414）。转为开胸手术的最常见原因是肺门淋巴结肿大。
SCAT 是一种处理 VATS 解剖性肺切除术中血管损伤的有效方法。在大多数情况下，使用这种方法可以控制出血并进行血管吻合，出血量可接受，从而避免紧急转为开胸手术。
