大咯血病人的外科治疗.docVIP

大咯血病人的外科治疗 【摘要】 目的 探讨大咯血病例外科治疗的时机。方法 对经外科治疗的29例大咯血病例手术时机、方式、效果、手术死亡率及死亡原因进行回顾性分析，确定最佳手术时机。结果 手术大咯血病例少量期（咯血量300ml～1500ml）10例、中等量期（咯血量1500～3000ml）8例、大量期（咯血量3000ml以上）11例;全肺切除8例，肺叶切除21例，手术成功率少量期、中等量期、大量期分别为100%、75%、54.5%;手术后并发症:胸腔感染6例，其中中等量期2例、大量期4例，全肺切除4例、肺叶切除2例;切口感染5例，其中中等量期2例，大量期3例;胸腔渗血7例。手术死亡7例，其中少量期无死亡，中等量期2例、大量期5例，死亡率分别为0%、25.0%、45.5%;手术死亡率与术中、术后出血、输血量呈正比。死亡原因:均因出血过多低血容量性休克、输血过多引起凝血功能紊乱致多脏器功能衰竭。结论 大咯血病人少量期手术疗效好、并发症少、死亡率低。 关键词 咯血 手术 并发症 死亡率 The surgical treatment on massive hemoptysis Feng Guixin，Hao Changcheng，Zheng Lijun. Department of Thoracic Surgery，The Second peoples Hospital of Weifang City，Shandong261041. 【Abstract】 Objective To explore the opportunity of surgical treatment on massive hemoptysis patients by reˉviewing the massive hemoptysis paitents.Methods To determine the opportunity of surgical operation，reviewthe opˉportunity，fashion，effect，death rate and cause of surgical operation from29cases of massive hemoptysis.Results Early stage（hemoptysis volume300～500ml）10cases，middle stage（hemoptysis volume1500～3000ml）8cases，later stage（hemoptysis volume over3000ml）11cases;There were8cases of resection of whole lungs and21cases resection of lung lobe;The success rate of operation of early，middle and later stage were100%，75.0%，54.5%respectively;The complication of operation:there were6cases of thoracic cavity infection，2cases in middle stage，and4cases in late stage，4cases of the whole lung resection and2cases of lung lob resection;there were5cases of incision infection，2cases in middle stage and3cases in later stage;there were7cases of death:no death in early stage，2cases in middl stage and5cases in later stage，The death rate of over was0%，25.0%，45.5%respectiveˉly;The mortility of operation is in positive proportion to the quantity of hemorrhage and blood transfusion in the course of operation and after operation.The death reasons are include all because losing excessive blood lead to hypovolemic shock，excessive blood transfusion lead to coagulation dy functi