Xie Junwei, Wang Hongliang, Han Tianci, Tong Wei, Guo Xiaoqi, Zhang Min, Liu Dongzhe, Zhang Liang, Liu Hongxu
Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China.
Department of Thoracic Surgery, Cancer Hospital of China Medical University, Shenyang, China.
Front Oncol. 2025 Aug 18;15:1588677. doi: 10.3389/fonc.2025.1588677. eCollection 2025.
This study aimed to systematically investigate the causes and management of secondary thoracotomy for hemostasis following lung cancer surgery. Although infrequent, secondary thoracotomy can lead to prolonged hospitalization, increased costs, and additional patient trauma. However, prior research has been limited to case reports or experience-based summaries, lacking a comprehensive analysis of this issue.
A retrospective analysis was conducted on 39 patients who underwent secondary thoracotomy for hemostasis between January 2015 and December 2022 at the Cancer Hospital of China Medical University. Data analyzed included surgical methods, tumor staging, bleeding sites, and hemostasis techniques. Statistical analysis was performed using SPSS 26.0; logistic regression was used to identify risk factors.
Among 15,156 patients who underwent lung surgery, 39 (0.257%) required secondary thoracotomy. Key risk factors were pleural adhesions (adjusted odds ratio [aOR] = 20.00), history of smoking (aOR = 3.56), and male sex (aOR = 3.21). Most secondary thoracotomies occurred within 24 hours post-surgery, with bleeding primarily at adhesion release sites and lung parenchymal injury. Electrocoagulation and suture ligation were the main hemostasis methods. The incidence of secondary thoracotomy decreased from 0.458% in 2015 to 0.178% in 2022, and this decrease correlates with increased adoption of thoracoscopic surgery.
Secondary thoracotomy for hemostasis is associated with specific risk factors such as pleural adhesions and history of smoking. This study highlights the importance of meticulous hemostasis, especially at adhesion sites and lung parenchymal injury. Advances in thoracoscopic surgery and surgical techniques have reduced secondary thoracotomy rates. Nevertheless, further research with larger samples is needed to explore the impact of metabolic diseases on this complication.
本研究旨在系统调查肺癌手术后二次开胸止血的原因及处理方法。二次开胸虽不常见，但可导致住院时间延长、费用增加及额外的患者创伤。然而，既往研究仅限于病例报告或基于经验的总结，缺乏对该问题的全面分析。
对2015年1月至2022年12月在中国医科大学附属肿瘤医院接受二次开胸止血的39例患者进行回顾性分析。分析的数据包括手术方法、肿瘤分期、出血部位及止血技术。使用SPSS 26.0进行统计分析；采用逻辑回归确定危险因素。
在15156例接受肺手术的患者中，39例（0.257%）需要二次开胸。关键危险因素为胸膜粘连（调整比值比[aOR]=20.00）、吸烟史（aOR=3.56）和男性（aOR=3.21）。大多数二次开胸发生在术后24小时内，出血主要发生在粘连松解部位和肺实质损伤处。电凝和缝合结扎是主要的止血方法。二次开胸的发生率从2015年的0.458%降至2022年的0.178%，且这种下降与胸腔镜手术的采用增加相关。
二次开胸止血与胸膜粘连和吸烟史等特定危险因素相关。本研究强调了精细止血的重要性，尤其是在粘连部位和肺实质损伤处。胸腔镜手术和手术技术的进步降低了二次开胸率。尽管如此，仍需要更大样本的进一步研究来探讨代谢性疾病对该并发症的影响。
