Measurement of injury of blood vessels in completely thoracotomy lobectomy
10.3760/cma.j.issn.1001-4497.2014.03.002
- VernacularTitle:全胸腔镜肺叶切除术中血管损伤致出血的应对措施
- Author:
Yun LI
;
Hui ZHAO
;
Guanchao JIANG
;
Jianfeng LI
;
Jun LIU
;
Jun WANG
- Publication Type:Journal Article
- Keywords:
Video-assisted thoracoscopic surgery;
Lobectomy;
Bleeding;
Injury;
Blood vessls
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2014;30(3):133-136
- CountryChina
- Language:Chinese
-
Abstract:
Objective Summarize cases of blood loss exceed 400 ml in completely video-assisted lobectomy procedure,and retrospective analysis the cause of injury of blood vessels in the operation and discuss the intro-operative measurement.Methods From September 2009 to April 2013,1006 patients underwent VATs lobectomy in our institution,with a median blood loss of 206.7 ml.There were 125 patients that the blood loss were exceed 400 ml (82 male,43 femal) with a median age of 62.0 years.The median diameter of the solid tumor was 3.2 cm.The lobectomy consist of 42 cases of right upper lobe,40 cases of left upper lobe,19 cases of right lower lobe,15 cases of left lower lobe and 9 cases of right middle lobe.The procedure consist of 99 cases of simple lobectomy,4 cases lobectomy combine with partial chest wall resection,16 cases of compound lobectomy,3 cases of sleeve lobectomy with bronchoplasty and 3 casesof pneumonectomy.The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported.Results All procedures were uneventful,with a median operative time of 269.3 minutes,a median blood loss of 666.1 ml.Among 125 cases with ＞ 400 mlof blood loss,there were 3 cases of injury of pulmonary vein,2 cases were repaired endoscopiclly (In one ease,the bleeding point was clipped directly and repaired with 5-0 non-absorbable suture.In another case,the pericardium was opened,the hilar vessels were blocked,and the wound was repaired with 5-0 non-absorbable suture) and 1 case that the vein was torn and massive bleeding occurred when passing an instrument through the posterior wall of the vein and conversion to open thoracotomy was performed to control bleeding and repair the vein with 5-0 non-absorbable suture.There were 13 cases of injury of pulmonary artery,in 2 cases that the proximal trunk of ipsilateral pulmonary artery was blocked endoscopically and hemostasis was assured and then repaired the pulmonary artery with 5-0 non-absorbable suture endoscopiclly and in 11 case,conversion to open thoracotomy was performed to control bleeding and to repair the artery.The median duration of chest tube drainage was 8.0 days; median length of hospital stay was 11.1 days.There were 22 cases need blood transfusion in the operation or postoperation.All patients recovered well,47 patients (36.0％) experienced a minor complication.Conclusion Injury of blood vessels was common and troublesome in completely thoracotomy lobectomy,and always lead to conversion to thoracotomy.The surgeon should deal with it based on the character of vessles,condition of injury and experience of the surg con.
