Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China.
Clin Respir J. 2024 Aug;18(8):e13810. doi: 10.1111/crj.13810.
Pulmonary resection is an important part of comprehensive treatment of lung cancer. Despite the progress in recent thoracic surgery, reoperation is occasionally inevitable for managing severe perioperative complications. This study aimed to investigate the incidence and causes of perioperative reoperation in lung cancer patients.
We retrospectively collected patients who underwent reoperation following pulmonary resection from January 2010 to February 2021 in China-Japan Friendship Hospital.
Among the 5032 lung cancer patients who received primary pulmonary resection in our institute, 37 patients underwent perioperative reoperation with the rate being 0.74%. Lobectomy was the most frequently executed procedure (56.8%). The mean duration of the primary surgery was 143.6 ± 65.1 min. About half of the cases received secondary surgery within 24 h of the primary surgery, whereas only one case underwent secondary surgery 30 days after the primary surgery (due to chylous leakage). The major causes of the reoperation were bleeding (73.0%), chylous leakage (13.5%), lobar torsion (5.4%), air leakage (2.7%), atelectasis (2.9%), and cardiac herniation (2.7%).
The most prevalent reasons for unplanned reoperation following pulmonary resection in lung cancer patients include bleeding, chylous leakage, and lobar torsion. The strict control of the surgical indications and standardization of surgical procedures are fundamental to reduce unplanned secondary operations after pulmonary resections. Timely identification of the need to secondary surgery is also important to ensure patients' safety.
肺切除术是肺癌综合治疗的重要组成部分。尽管近年来胸外科取得了进展，但对于严重围手术期并发症的处理，仍偶尔需要再次手术。本研究旨在探讨肺癌患者围手术期再次手术的发生率和原因。
我们回顾性收集了 2010 年 1 月至 2021 年 2 月在中国医学科学院肿瘤医院行再次肺切除术的患者资料。
在我院接受初次肺切除术的 5032 例肺癌患者中，有 37 例患者行围手术期再次手术，再次手术率为 0.74%。肺叶切除术是最常施行的术式（56.8%）。初次手术的平均时间为 143.6±65.1min。约一半的病例在初次手术后 24h 内接受二次手术，而只有 1 例在初次手术后 30 天（因乳糜漏）接受二次手术。再次手术的主要原因是出血（73.0%）、乳糜漏（13.5%）、肺叶扭转（5.4%）、漏气（2.7%）、肺不张（2.9%）和心脏疝（2.7%）。
肺癌患者肺切除术后计划性再次手术的最常见原因包括出血、乳糜漏和肺叶扭转。严格掌握手术适应证和规范手术操作是减少肺切除术后计划性二次手术的基础，及时识别需要二次手术的情况对保证患者安全也很重要。
