Miyazaki Takuro, Yamasaki Naoya, Tsuchiya Tomoshi, Matsumoto Keitaro, Hatachi Go, Kitamura Yuka, Obata Tomohiro, Doi Ryoichiro, Machino Ryusuke, Nagayasu Takeshi
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Surg Today. 2016 Aug;46(8):901-7. doi: 10.1007/s00595-015-1253-9. Epub 2015 Sep 28.
Unexpected intraoperative bleeding during thoracoscopic surgery, necessitating emergency conversion to thoracotomy, is gradually being reported. We reviewed our experience of encountering unexpected bleeding during thoracoscopic surgery.
We defined "unexpected intraoperative bleeding" as the need for hemostatic procedures with angiorrhaphy, with or without a sealant. The location, cause, and management of injured vessels, and perioperative outcomes were investigated and compared with those for patients without injured vessels.
Between 2007 and 2014, a total of 241 thoracoscopic anatomical pulmonary resections were performed at our hospital. Twenty (8.3 %) of these patients required hemostatic procedures with angiorrhaphy, with or without a sealant. The main injured vessels were the pulmonary artery (n = 13) and vein (n = 3) and the main causes of injury were related to technical issues with energy devices and staplers. There were no morbidities related to intraoperative bleeding. The operation time and blood loss were significantly greater in the patients with vessel injury than in those without vessel injury, but perioperative morbidities and the duration of chest tube insertion (4.5 vs. 3.5 days, average, p = 0.20) and postoperative hospital stay (12.7 vs. 11.0 days, average, p = 0.08) were not significantly different.
The frequency of unexpected bleeding was relatively high in this series, but its management and outcomes were satisfactory in terms of safety.
胸腔镜手术中意外的术中出血，需要紧急转为开胸手术，这种情况的报道逐渐增多。我们回顾了我们在胸腔镜手术中遇到意外出血的经验。
我们将“意外术中出血”定义为需要进行血管缝合止血操作，无论是否使用密封剂。对受伤血管的位置、原因、处理方法以及围手术期结果进行了调查，并与未受伤血管的患者进行了比较。
2007年至2014年期间，我院共进行了241例胸腔镜解剖性肺切除术。其中20例（8.3%）患者需要进行血管缝合止血操作，无论是否使用密封剂。主要受伤血管为肺动脉（n = 13）和肺静脉（n = 3），受伤的主要原因与能量设备和吻合器的技术问题有关。没有与术中出血相关的并发症。血管损伤患者的手术时间和失血量明显高于未发生血管损伤的患者，但围手术期并发症、胸管留置时间（平均4.5天对3.5天，p = 0.20）和术后住院时间（平均12.7天对11.0天，p = 0.08）差异无统计学意义。
在本系列中，意外出血的发生率相对较高，但就安全性而言，其处理方法和结果令人满意。
