行全身胸部外科手术患者发生并发症后行早期再次手术治疗。
Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures.
机构信息
1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
出版信息
J Thorac Dis. 2014 Mar;6 Suppl 1(Suppl 1):S21-31. doi: 10.3978/j.issn.2072-1439.2014.02.22.
OBJECTIVE
To detect the rate and predisposing factors for the development of postoperative complications requiring re-operation for their control in the immediate postoperative period.
METHODS
During the time period 2009-2012, 719 patients (male: 71.62%, mean age: 54±19 years) who underwent a wide range of general thoracic surgery procedures, were retrospectively collected. Data of patients who underwent early re-operation for the management of postoperative complications were assessed for identification of the responsible causative factors.
RESULTS
Overall, 33/719 patients (4.6%) underwent early re-operation to control postoperative complications. Early re-operation was obviated by the need to control bleeding or to drain clotted hemothoraces in nine cases (27.3%), to manage a prolonged air leak in six cases (18.2%), to drain a post-thoracotomy empyema in five cases (15.2%), to revise the thoracotomy incision or an ischemic musculocutaneous flap in five cases (15.2%), to manage a bronchopleural fistula in four cases (12.1%), to manage persistent atelectasis of the remaining lung in two cases (6.1%), to cease a chyle leak in one case (3%) and to plicate the right hemidiaphragm in another one case (3%). The factors responsible for the development of complications requiring reopening of the chest for their management were technical in 17 cases (51.5%), initial surgery for lung or pleural infections in 9 (27.3%), the recent antiplatelet drug administration in 4 (12.1%) and advanced lung emphysema in 3 (9.1%). Mortality of re-operations was 6.1% (2/33) and it was associated with the need to proceed with completion pneumonectomy in the two cases with persistent atelectasis of the remaining lung and permanent parenchymal damage. The majority of complications requiring reoperation were observed after lung parenchyma resection (17 out of the 228 procedures/7.4%) or pleurectomy (7 out of the 106 procedures/6.5%). Reoperations after video-assisted thoracic surgery (VATS) were uncommon (2 out of the 99 procedures/2%).
CONCLUSIONS
The rate of complications requiring reoperation after general thoracic surgery procedures is low and it is mainly related to technical issues from the initial surgery, the recent administration of antiplatelet drugs, the presence of advanced emphysema and surgery for infectious diseases. The need to proceed with completion pneumonectomy has serious risk for fatal outcome.
目的
检测需要再次手术控制的术后并发症的发生率和易患因素，这些并发症发生在术后即刻。
方法
在 2009 年至 2012 年期间，回顾性收集了 719 名（男：71.62%，平均年龄：54±19 岁）接受各种普通胸外科手术的患者的数据。评估了接受早期再次手术以控制术后并发症患者的数据，以确定负责的致病因素。
结果
总体而言，33/719 名患者（4.6%）因术后并发症需要早期再次手术。有 9 例（27.3%）因需要控制出血或引流血凝块性血胸，6 例（18.2%）因需要管理长时间的漏气，5 例（15.2%）因需要引流开胸后脓胸，5 例（15.2%）因需要修改切口或缺血性肌皮瓣，4 例（12.1%）因需要处理支气管胸膜瘘，2 例（6.1%）因需要处理剩余肺不张，1 例（3%）因需要停止乳糜漏，另 1 例（3%）因需要折叠右膈肌而再次手术。需要再次开胸处理并发症的原因包括技术原因 17 例（51.5%），肺部或胸膜感染手术 9 例（27.3%），近期使用抗血小板药物 4 例（12.1%）和晚期肺气肿 3 例（9.1%）。再次手术的死亡率为 6.1%（2/33），这与需要进行永久性全肺切除术的 2 例剩余肺不张和永久性实质损伤相关。需要再次手术的大多数并发症发生在肺实质切除术后（228 例手术中的 17 例/7.4%）或胸膜切除术后（106 例手术中的 7 例/6.5%）。电视辅助胸腔镜手术（VATS）后的再次手术较少见（99 例手术中的 2 例/2%）。
结论
普通胸外科手术后需要再次手术的并发症发生率较低，主要与初始手术的技术问题、近期使用抗血小板药物、晚期肺气肿和感染性疾病手术有关。需要进行全肺切除术会有严重的致命风险。
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