Kiral Hakan, Evman Serdar, Tezel Cagatay, Alpay Levent, Lacin Tunc, Baysungur Volkan, Yalcinkaya Irfan
Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Department of Thoracic Surgery, Istanbul, Turkey.
Ann Thorac Cardiovasc Surg. 2015;21(2):125-31. doi: 10.5761/atcs.oa.14-00164. Epub 2015 Mar 2.
Massive hemoptysis is a life threatening situation with high mortality rates. Surgery is effective, however generally an avoided treatment. We report our experience with patients undergoing lung resection for life-threatening hemoptysis.
Records of all surgically treated patients for hemoptysis between June 2009 and June 2012 were reviewed and analyzed retrospectively.
Anatomical resection was performed on 31 (15.3%) patients out of 203 patients referred to our intensive care unit for life-threatening hemoptysis. 25 (80.6%) were male and six (19.4%) were female; with mean age of 46.4 ± 13.7 (21-77). Pneumonectomy was performed in four (12.9%), lobectomy in 24 (77.4%), segmentectomy in two (6.5%) and bilobectomy in one case. Postoperative complications developed in eight (25.8%), and mortality was observed in two (6.5%) patients. Etiology was bronchiectasis in 13 (42.0%), tuberculosis in eight (25.8%), carcinoma in four (12.9%), aspergilloma in four (12.9%), hydatid cyst in one (3.2%) and lung abscess in one (3.2%) of the cases.
Although lung resection in the treatment of massive hemoptysis is accompanied with high morbidity and mortality rates, surgery is the only permanent curative modality. Acceptable results can be achived in the company of a multidisciplinary approach, through avoidance of pneumonectomy and urgent surgery.
大量咯血是一种危及生命的情况,死亡率很高。手术是有效的,但通常是一种应避免的治疗方法。我们报告了对因危及生命的咯血而接受肺切除术的患者的治疗经验。
回顾性分析2009年6月至2012年6月期间所有因咯血接受手术治疗患者的记录。
在转诊至我们重症监护病房的203例因危及生命的咯血患者中,31例(15.3%)接受了解剖性切除。男性25例(80.6%),女性6例(19.4%);平均年龄46.4±13.7岁(21 - 77岁)。4例(12.9%)行全肺切除术,24例(77.4%)行肺叶切除术,2例(6.5%)行肺段切除术,1例双侧肺叶切除术。8例(25.8%)出现术后并发症,2例(6.5%)患者死亡。病因分别为支气管扩张13例(42.0%)、肺结核8例(25.8%)、癌症4例(12.9%)、曲霉菌球4例(12.9%)、包虫囊肿1例(3.2%)和肺脓肿1例(3.2%)。
虽然肺切除术治疗大量咯血伴随着高发病率和死亡率,但手术是唯一的永久性治愈方式。通过多学科方法,避免全肺切除术和急诊手术,可以取得可接受的结果。