Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Diseases, Thoracic Surgery Unit, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy.
Thorac Cardiovasc Surg. 2022 Dec;70(8):671-676. doi: 10.1055/s-0041-1727129. Epub 2021 Apr 13.
Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized.
We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed.
After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1-13) after ABPP were also statistically different ( < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis.
In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.
肺切除术后最常见的并发症是空气漏，这会导致住院时间延长（LOH）或带管出院。自体血贴胸膜固定术（ABPP）的管理存在争议，因为研究较少，而且该技术尚未标准化。
我们回顾性分析了 2014 年 1 月至 2019 年 12 月在三个中心接受 ABPP 治疗的肺叶切除术后持续空气漏（PAL）的患者。他们分为两组：A 组，输注 120 毫升血液；B 组，输注 60 毫升。采用倾向评分匹配（PSM）分析，每组纳入 23 例患者。检查血贴的数量和成功率、停止漏气的时间、拔除胸腔引流管的时间、再次手术、LOH 和并发症。对与空气漏风险增加相关的变量进行单变量和多变量分析。
PSM 后，ABPP 后拔除胸腔引流管前的天数（2.78 天比 4.35 天）、ABPP 后 LOH（3.78 天比 10.00 天）和 LOH（8.78 天比 15.17 天）减少具有统计学意义。ABPP 后并发症（0 比 4）和空气漏停止时间（6.83 比 3.91 小时，范围 1-13 小时）也有统计学差异（ < 0.05）。持续 13 小时的空气漏需要再次行 ABPP。无患者行再次手术或与胸膜固定术相关的长期并发症。
根据我们的经验，120 毫升是最佳的血量，并且可以在夹闭胸腔引流管的情况下每 24 小时重复该操作。
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