Mei J D, Pu Q, Ma L, Liu C W, Liu L X
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Wai Ke Za Zhi. 2017 Dec 1;55(12):898-902. doi: 10.3760/cma.j.issn.0529-5815.2017.12.005.
The technique of thoracoscopic lung surgery has gradually matured. Nowadays, thoracoscope is recommended as the most preferred approach for surgical treatment of early stage non-small cell lung cancer in different guidelines. However, there are still some cases of accidential major bleeding due to vascular injury during thoracoscopic lung surgery. The wall of the hilum vessels is relatively thin. These vessels often involve a great portion of the cardiac output blood flow. Once the injury happened, the emergent condition may be life-threatening due to massive blood loss. Therefore, this became an important factor which hindered the development of thoracoscopic lung surgery. In this review, details of the vascular injury in thoracoscopic lung surgery were summarized, including the incidence of vascular injury, commonly injured sites and reasons of the injuries. Among all the cases of thoracoscopic major pulmonary resection, 2.9% to 9.2% may suffer from vascular injury during the operation. The most commonly injuried sites are pulmonary artery and the branches, and this is also the most critical situation during thoracoscopic lung surgery. Hilum adhesion is the most important risk factor for vascular injury. On the one hand, the suction-compressing angiorrhaphy technique was developed for bleeding control and angioplasty. On the other hand, the strategies like pre-control of the pulmonary, cut the bronchus in advance, and fire the bronchus and pulmonary artery together may decrease the incidence of vascular injury in patients with risk factors.
胸腔镜肺手术技术已逐渐成熟。如今，在不同的指南中，胸腔镜被推荐为早期非小细胞肺癌手术治疗的最优选方法。然而，胸腔镜肺手术期间仍存在因血管损伤导致意外大出血的一些病例。肺门血管壁相对较薄。这些血管通常涉及很大一部分心输出血量。一旦发生损伤，由于大量失血，紧急情况可能危及生命。因此，这成为阻碍胸腔镜肺手术发展的一个重要因素。在本综述中，总结了胸腔镜肺手术中血管损伤的细节，包括血管损伤的发生率、常见损伤部位及损伤原因。在所有胸腔镜下肺叶切除病例中，2.9%至9.2%的患者在手术期间可能发生血管损伤。最常受损的部位是肺动脉及其分支，这也是胸腔镜肺手术中最危急的情况。肺门粘连是血管损伤最重要的危险因素。一方面，开发了吸引压迫血管缝合技术用于控制出血和血管成形术。另一方面，像预先控制肺门、提前切断支气管以及同时切断支气管和肺动脉等策略可能会降低有危险因素患者的血管损伤发生率。
