Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
Surg Endosc. 2019 Jun;33(6):1880-1889. doi: 10.1007/s00464-018-6467-7. Epub 2018 Sep 26.
Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis.
Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury.
There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity.
In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
我们的目的是报告两个中心在单孔电视辅助胸腔镜（SPVATS）解剖性肺切除术中处理大血管损伤的经验，包括出血控制技术、发生率、结果和风险因素分析。
连续纳入在两个中心接受 SPVATS 解剖性肺切除术的患者（n=442）。研究的不同临床参数包括年龄、既往胸部手术史、肥胖（BMI>30）、肿瘤位置、新辅助治疗和胸膜融合。此外，还比较了有或无血管损伤的两组患者的围手术期结局。
本研究中无术中死亡。总体大出血发生率为 4.5%，其中 70%的大出血事件可以通过 SPVATS 技术进行处理。为了确定可能与术中出血相关的风险因素，我们使用病例对照匹配来使我们的研究人群同质化。病例对照匹配后，胸膜融合在单因素（p=0.005，优势比 4.415，95%可信区间 1.424-13.685）和多因素分析（p=0.006，优势比 4.926，95%可信区间 1.577-15.384）中均有显著相关性。有大血管损伤的患者手术时间（p<0.001）、出血量（p<0.001）和术后住院时间（p=0.012）较长。30 天死亡率和 90 天发病率无差异。
总之，SPVATS 解剖性肺切除术中的主要术中出血是可以接受的，大多数此类出血可以通过 SPVATS 技术安全处理。
