摘要
目的探讨胸腔镜支气管动脉结扎治疗大咯血的临床效果。方法收治的60例大咯血患者作为研究对象,2012年9月至2015年3月患者采用胸腔镜肺叶切除术(切除组),2015年4月至2017年8月患者采用胸腔镜支气管动脉结扎(结扎组)。观察2组患者手术指标(手术时间、术中出血量、胸腔引流量、带管时间和住院时间)、并发症情况,随访1年,观察2组复发和生存情况。比较2组治疗效果。结果结扎组均一次治疗成功,术后停止咯血23例,咯血明显减少7例。结扎组术中出血量、胸腔引流量均少于切除组,带管时间、住院时间短于切除组,差异均有统计学意义(P<0.05);结扎组手术时间短于切除组,但差异无统计学意义(P>0.05)。切除组高热、感染、胸痛、恶心呕吐发生率均高于结扎组,但差异无统计学意义(P>0.05);结扎组并发症总发生率低于切除组,差异有统计学意义(P<0.05)。随访1年,结扎组3个月后复发2例,其中肺癌咯血1例,肺结核咯血1例,但咯血量较术前减少,行造影示病灶由肋间动脉重新建立新的血供所致,给予栓塞后即刻止血。切除组大咯血复发率高于结扎组,差异有统计学意义(P<0.05);结扎组生存率高于切除组,但差异无统计学意义(P>0.05)。2组疗效比较差异无统计学意义(U=1.336,P>0.05),结扎组治愈率、显效率、总有效率略高于切除组,但差异无统计学意义(P>0.05)。结论支气管动脉结扎术能有效控制咯血,它不需要精确定位,有创伤小,恢复快,疗效确切,为不能耐受较大手术的咯血患者提供一种新的治疗方法。
Objective To investigate the clinical effects of thoracoscopic bronchial artery ligation in treatment of large hemoptysis. Methods Sixty patients with large hemoptysis who were treated in our hospital from September 2012 to March2015 were enrolled in the study,who underwent thoracotomy(lobectomy group),and the patients with large hemoptysis who were treated in our hospital from April 2015 to August 2017 underwent thoracoscopic bronchial artery ligation(ligation group). The surgical indexes including operation time,intraoperative blood loss,chest drainage,catheterization time and hospitalization time as well as complications were observed and compared between the two groups. Moreover the patients in both groups were followed up for 1 year,and the recurrence rate,survival status and therapeutic effects were observed and compared between the two groups. Results In ligation group,the patients were treated successfully in one time,there were 23 cases of immediate hemostasis and 7 cases of hemoptysis decrease. The amount of bleeding and chest drainage during operation in ligation group were less than those in lobectomy group,and the catheterization time and hospitalization time were significantly shorter than those in lobectomy group(P < 0. 05). The operation time in ligation group was shorter than that in lobectomy group,but there was no significant difference between the two groups(P > 0. 05). The incidence rates of high fever,infection,chest pain,nausea and vomiting in lobectomy group were higher than those in ligation group,but the difference was not statistically significant(P > 0. 05). The total incidence rate of complications in ligation group was significant lower than that in lobectomy group(P < 0. 05). After 1-year follow-up,2 patients relapsed after 3 months in ligation group,including 1 case of hemoptysis due to lung cancer and 1 case of hemoptysis due to pulmonary tuberculosis,but the amount of hemoptysis was reduced,as compared with that before operation. The angiography showed that the lesion was caused by the reestablishment of new blood supply from the intercostal artery,and the bleeding was immediately stopped after embolization. The recurrence rate of large hemoptysis in lobectomy group was significantly higher than that in ligation group(P < 0. 05). The survival rate in ligation group was higher than that in lobectomy group,but the difference was not statistically significant(P > 0. 05). There were no significant differences in the therpeutic effects between the two groups(P > 0. 05). The cure rate,effective rate and total effective rate in ligation group were higher than those in lobectomy group,however,there were no significant differences between the two groups(P >0. 05). Conclusion Bronchial artery ligation can effectively control hemoptysis,which does not require precise positioning,has the advantages of small trauma,quick recovery,and definite therapeutic effects,therefor,which provides an new treatment method for hemoptysis patients who can not tolerate major surgery.
作者
和宇峥
张合林
李帅
李海涛
周连亚
石彦涛
刘瑞林
HE Yuzheng;ZHANG Helin;LI Shuai(Department of Thoracic Surgery,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)
出处
《河北医药》
CAS
2019年第13期1966-1969,1973,共5页
Hebei Medical Journal
基金
河北省医学科学研究重点课题计划(编号:ZL20140302)
关键词
大咯血
胸腔镜
支气管动脉结扎
肺叶切除术
治疗结果
large hemoptysis
thoracoscope
bronchial artery ligation
lobectomy
treatment outcome
