大量咯血的肺切除手术治疗32例临床分析

目的　探讨肺切除治疗大咯血手术的适应证及手术时机。方法 对 1985～2000年 32例肺切除治疗大咯血病人的手术效果进行回顾分析。结果 大咯血病人施行肺切除 32例,治愈率 87.5%,并发症 12.5%。结论 手术适应证趋于积极,即非手术治疗效果不佳,出血部位确定,肺功能,全身状况良好,尽早施行手术,当患者出现窒息或低血压时应抓紧手术时机。因并发症和死亡率仍高于常规肺切除,故需严格掌握手术指征。     

大量咯血的肺切除手术治疗32例临床分析

目的：探讨肺切除治疗大咯血手术的适应证及手术时机。方法：对1985－2000年32例肺切除治疗大咯血病人的手术效果进行回顾分析。结果：大咯血病人施行肺切除32例，治愈率87．5％，并发症12．5％。结论：手术适应证趋于积极，即非手术治疗效果不佳，出血部位确定，肺功能，全身状况良好，尽早施行手术，当患者出现窒息或低血压时应抓紧手术时机。因并发症和死亡率仍高于常规肺切除，故需严格掌握手术指征。     

急诊肺切除治疗大量咯血手术适应证探讨

报道１９８３年１月～１９９２年１２月大咯血施行急诊肺切除２４例，治愈率９５．８％，并发率１６．６％，死亡率０％。较作者１９８６年报道５４例疗效有所提高。资料显示：手术适应证趋于积极，即非手术治疗效果不佳，出血部位确定，心肺功能和全身状况许可，尽早施行手术，尤其当患者曾出现过窒息、窒息先兆或低血压、休克时更应抓紧手术时机。因并发率和死亡率仍高于常规肺切除，故需严格掌握手术指征。对二侧病变、咯血来源不能确定、全身情况或心肺功能差者宜行支气管动脉栓塞治疗。     

肺结核咯血的外科治疗及疗效观察

目的 探讨肺结核合并咯血的外科治疗的适应证及手术方法.方法 回顾分析2008年10月至2012年10月在我院治疗的42例肺结核合并咯血患者的临床资料.结果 本组42例患者,行全肺切除1例,肺叶切除30例,肺楔形切除11例.术后仍有少量咯血5例,术后胸腔内出血而再次行手术治疗1例,术后肺不张、胸腔积液4例,切口感染2例,支气管胸膜瘘2例;并发症发生率为21.4％ (9/42),治愈率88.1％ (37/42).结论 外科手术是治疗肺结核大咯血和长期反复少量或中量咯血的综合治疗措施中较为有效的方法,手术原则以择期手术下肺叶切除方式为主.     

58例肺曲霉菌病患者的临床特点及预后影响因素分析

目的探讨肺曲霉菌病的临床特点,为肺曲霉菌病的诊断及治疗提供借鉴。方法对58例肺曲霉菌病患者的临床特点、影像学检查、治疗经过及预后影响因素进行回顾性分析。结果出现咯血症状48例(82.7%),有肺结核病史45例(77.6%)。CT图像出现较典型的新月征37例(63.8%),出现随体位移动的球形影8例(13.8%)。药物治疗可控制咯血症状,但对大咯血及霉菌球效果不明显。因大咯血行急诊介入动脉栓塞止血治疗28例,其中12例出现再咯血而转手术治疗。行手术治疗47例,无术中及术后30 d内死亡患者,术后未出现再咯血。随访1~130个月,无因本病复发而死亡者。未行手术治疗者11例,其中随访期间死亡7例。高龄(>50岁)、大咯血及未手术为预后的独立危险因素(P均<0.05)。结论手术是肺曲霉菌病较好的治疗方法,高龄、大咯血及未行手术治疗者预后较差。     

167例咯血患者临床诊治分析

目的分析咯血的病因及治疗。方法收集2008年4月至2012年4月我科收治的167例咯血患者的临床资料,进行回顾性分析。结果咯血病因前三位为支气管扩张、肺癌、肺结核,肺血管性疾病占3.6%,小量至中等量咯血以内科保守治疗为主,大咯血及难治性咯血需介入或手术治疗。结论咯血的病因以支气管扩张、肺癌、肺结核为主,但随着CT及介入技术的发展,肺血管性疾病不断可明确诊断。介入止血可为大咯血或难治性咯血的首选方法。     

支气管镜下一次置入二根新型双腔微导管治疗肺大咯血初探

不少患者的大咯血难以控制,甚至危及患者生命,尤其在碘过敏及难以耐受手术和疑为肺动脉血管破裂出血的患者,我们采用支气管镜下1次置入2根新型双腔微导管治疗方法,防止肺大咯血可能所致窒息,也为针对病因治疗和手术切除争取宝贵时间,其疗效确切,现报告如下.     

COPD并自发性气胸行肺大疱切除加单侧肺减容术临床分析

目的报道急诊或亚急诊肺大疱切除加单侧肺减容术治疗COPD并自发性气胸的临床结果。方法对32例COPD并自发性气胸患者实施肺大疱切除加单侧肺减容术,术后随访24个月,分别于术后第6、12、24个月测定动脉血气分析值。结果术后第6、12、24个月与术前相应数值比较,均有明显好转（P〈0.05）。全组无手术死亡,术后并发症发生率在35%左右。结论肺大疱切除加单侧肺减容术可以改善COPD并自发性气胸患者的临床症状,且手术死亡率低,尽量切除肺大疱及病变侧过度气肿的肺组织和防止残肺漏气为手术关键,做好围手术期的处理,能明显减少术后并发症。     

介入栓塞治疗肺动脉假性动脉瘤伴大咯血的临床疗效分析

目的 探讨体肺双途径栓塞治疗肺动脉假性动脉瘤(pulmonary artery pseudoaneurysms,PAPs)伴大咯血的临床疗效及安全性.方法 回顾性分析2016年1月至2018年2月海南医学院第二附属医院收治的经CT血管造影(CT angiography,CTA)/数字减影血管造影(digital subtractive angiography,DSA)证实为PAPs伴大咯血的15例肺结核患者的临床资料.记录相关影像学表现、介入治疗技术和临床止血成功情况,随访1年内咯血复发状况.结果 共发现15个PAPs,肺CTA发现14个,血管造影发现1个.术中仅支气管动脉造影发现6个,仅肺动脉造影发现4个,支气管动脉及肺动脉造影均发现4个,1个体肺动脉造影均未发现.介入栓塞术后咯血有效止血14例,1例患者术中因大咯血窒息导致死亡.患者随访12个月,其中1例患者术后2周复发大咯血行外科切除术;1例咯血术后3个月余复发,再次行介入栓塞后咯血停止.结论 经体肺双途径栓塞治疗肺结核患者PAPs伴大咯血的临床疗效确切,方法可行,但仍有一定风险.     

支气管动脉栓塞术治疗大咯血的疗效分析

目的 :探讨支气管动脉栓塞术治疗大咯血的疗效。方法 :36例大咯血患者用明胶海绵颗粒行支气管动脉栓塞。患者肺部基础病变包括 :支气管扩张 13例 ,肺结核 11例 ,肺癌 9例 ,肺脓肿 1例 ,隐源性咯血 2例。结果 :2 9例即刻止血 (80 .6 % )。在 2年的随访中 ,术后 15d内复发大咯血并窒息死亡者 4例 ,另外 4例复发咯血者 ,3例再次行BAE治疗。支气管动脉栓塞术后因复发而行手术治疗者 2例。因此 ,2年随访总的有效率和复发率分别为 83.3%和 2 2 .8%。主要的并发症为自限性的短暂胸痛和发热。结论 :支气管动脉栓塞术是大咯血的一种安全、微创、高效的治疗方法     

肺结核并大咯血窒息的救治

目的提高肺结核并大咯血窒息的重症救治水平。方法对我院重症医学科(ICU)收治的肺结核并大咯血窒息22例进行总结分析,通过紧急气管插管,通畅呼吸道,呼吸机辅助通气,保证氧合,补充血容量维持血压稳定,床旁纤支镜清除气道内血块,静脉输注止血药物及血管活性药物,纠正贫血、补充凝血因子,局部冰敷,加强营养支持等治疗。结果 22例患者中抢救成功转出ICU 20例,抢救成功率90.91%;死亡2例,死亡率9.09%。结论肺结核并大咯血窒息的重症救治前提是保证呼吸道通畅,机械通气进行肺复苏、及时止血、维持生命征稳定是抢救成功的关键。     

隐源性咯血的介入诊断和治疗

目的 探讨隐源性咯血的支气管动脉造影 (BAG)的影像表现与病理机制之间的关系,为其诊断和出血定位寻求可靠依据。方法 1 选择隐源性咯血病人52例,包括以下两种情况：(1)常规影像学检查阴性 (胸部平片、断层阴性,部分病人同期CT及支气管碘油造影阴性) (2)一个肺叶或一侧肺内有少量病变,但BAG证实为非咯血病灶,而另叶或另段肺内有出血征象,计17例。全部病例行Seldinger穿刺技术,导管经主动脉置入双侧支气管动脉造影,确认有造影的直接或间接出血征象,行双重栓塞术。2 另选5例术前影像学检查证实为支气管病变、BAG检查证实为出血部位和出血原因的病例,因栓塞止血无效或其他病变而行手术切除。对5例手术切除标本进行病理镜下检查,分析其与BAG所见的相关性。结果 全部咯血病例,BAG均有不同程度的血管增生紊乱,典型者为扫帚状或网状增生、紊乱的血管束,严重者伴有肺内出血病灶。结合支气管扩张手术标本中的病理所见,如支气管周围支气管动脉的血管数增多、扭曲等,两者的血管改变呈一致性。结论 1 隐源性咯血的病理机制为支气管动脉损伤,而支气管动脉的损伤又为支气管动脉感染所致。故经BAG提示的血管异常改变可以为隐源性咯血的诊断和出血定位提供依据。2 支气管动脉造影和栓塞集诊断与治疗为一体,病人创伤小,且安全有效,在抢救大咯血方面具有实际意义,为控制大咯血提供了一种实用的新途径。     

经纤维支气管镜微导管治疗肺大咯血几种不同置人方法安全性的评价

目的探讨经纤维支气管镜微导管治疗肺大咯血几种不同置入方法的安全性。方法总结我科2010年10月至2011年12月大咯血患者10例,均为男性,通过对比观察手术过程难易程度、耗费时间、并发症等指标及治疗效果判定,对导丝引导法（方法A）、并行法（方法B）、体外留置支气管镜法（方法C）三种经纤支镜置入微导管治疗肺大咯血的安全性进行评价。结果在10例患者中,方法A完成3例,方法B完成2例,方法C完成5例,三种不同方法经纤维支气管镜下置入微导管操作均顺利,操作时间3—30min不等。方法A、B中均有病例出现鼻腔出血、声音嘶哑,方法C则无。三种方法中均无明显胸痛、肺不张、阻塞性肺炎、导管滑脱及局部支气管黏膜坏死的发生。结论对于微导管置人方法的选择,应选择术者较熟练、简便、费时短的方法,以充分保证患者的安全。体外留置纤支镜法置入微导管值得在肺大咯血中进一步推广应用。     

The surgical emergent therapy for massive hemoptysis in 52 cases]

The result of surgical emergent operation in 52 cases with massive hemoptysis failed by medical therapy was reported. Hemoptysis ceased in 51 of the 52 cases. One patient died after operation, giving a mortality rate of 1.9%. Other complications were occurred in two patients, but none was bronchial fistula. The complication rate was 3.8%. The surgical indication of this series would include: (1) The amount of hemoptysis more than 600 ml per 24 h, failed by medical treatment. (2) Massive hemoptysis repeated or a history of suffocation. (3) Irreversible lesion in the lung with the bleeding site identified accurately. (4) The general condition and vital organs of the patient would permit surgical therapy. Various types of pulmonary resection with successful results should be selected.     

Surgical management of pulmonary cavity associated with fungus ball

Surgery for pulmonary cavity associated with fungus ball is challenged by chronic lung disease. The purpose of this report was to review patient data, operative procedures and results of surgery. This was a retrospective study. Twenty patients were operated on between January 1997 and December 2002. Fourteen (70%) patients were male and the mean age was 46.30 +/- 13.10 years (range, 24 to 76 years). The most common underlying pulmonary disorder was tuberculosis (70%). Ninety five percent of the patients had a history of hemoptysis, and 35% presented with massive hemoptysis. Lobectomy was performed in 11 (55%) patients and 6 (30%) patients were operated on by cavernostomy with transposition of muscle flap technique. There was no operative mortality and 8 complications (3 prolonged airleaks, 2 wound infections, 1 postoperative bleeding, 1 seroma and 1 empyema). It was also found that emergency surgery and cavernostomy with transposition of muscle flap compromised the postoperative course. Surgery is very effective in controlling and preventing hemoptysis in patients who have pulmonary cavity associated with fungus ball. Elective surgery and formal pulmonary resection may be the proper option for low risk patients. Cavernostomy with transposition of muscle flap may be suitable for patients who have poor pulmonary reserve.     

COMPLICATIONS ASSOCIATED WITH ENDOSCOPIC MUCOSAL RESECTION: DEFINITION OF BLEEDING THAT CAN BE VIEWED AS ACCIDENTAL

The consensus reached during the meeting on complications associated with EMR entitled ‘The definition of bleeding that can be viewed as accidental’ was held at the third EMR Conference, December 20, 2003, in Tokyo is as follows. (1) The definition of complications associated with EMR as intraoperative bleeding is cases requiring special measures such as emergency surgery, intraoperative blood transfusion, or vasopressor therapy and cases where EMR has to be necessarily discontinued because of intraoperative bleeding; and (2) the definition of complications associated with EMR as postoperative bleeding is marked bleeding from the ulcer‐affected area after EMR, requiring special measures for hemostasis. Bleeding during or after EMR may be deemed as accidental if the Hb level falls by 2 g/dL or more in comparison with the last preoperative level, or if any of apparent bleeding or massive melena, etc. is seen. Providing a clear definition for ‘apparent bleeding’ and ‘massive melena’ was left open to debate.     

Etiology and treatment outcomes of massive hemoptysis

Massive hemoptysis is a life-threatening condition and can lead to asphyxiation. This is a retrospective review of 101 patients hospitalized with massive hemoptysis at Srinagarind Hospital, Khon Kaen, Thailand, between January 1993 and December 2002. The male to female ratio was 2.1:1. The average age was 47.1 (SD 16.8) years. Half the subjects were farmers and three-fourths had an underlying disease; most notably old pulmonary tuberculosis (41.6%). The mean duration of massive hemoptysis was 3.2 (SD 3.7) days. An initial hematocrit < or = 30% was found in 34.6% of patients, and a prolonged prothrombin time in 4.0%, and thrombocytopenia in 2.0%. Chest radiographs revealed unilateral, bilateral lesions and normal lungs in 57.4, 40.6, and 2.0%, respectively. A chest CT was done in 14.8% of patients. Bronchoscopy localized the bleeding and diagnosed the etiology in 19.8%. The most common causes of massive hemoptysis were bronchiectasis (33.7%), active pulmonary tuberculosis (20.8%) and malignancy (10.9%). Patients were grouped by treatment: 1) conservative (88); 2) emergency bronchial artery embolization (7); and, 3) emergency surgery (6). Of the 88 patients in group 1, the bleeding was stopped in 71 (80.7%) and recurred in 4. Of the 7 patients undergoing emergency bronchial artery embolization, the bleeding was stopped in 6 (86%) and recurred in 1. In the 6 patients who underwent emergency surgery, the bleeding was stopped in all and recurred in 1. Recurrent hemoptysis usually arose within 7 days of the first episode and was well controlled with bronchial arterial embolization. The mortality rate was 17.8%. Of the discharged patients, 36.1% had recurrent hemoptysis. Most of them occurred within one month after discharge. We conclude that, the most common cause of massive hemoptysis is benign rahter than malignant disease. Intensive care with conservative treatment should be applied vigorously. Bronchial artery embolization is an excellent, non-surgical alternative to control bleeding, and should be done before specific surgical intervention.     

支气管动脉CTA与支气管动脉栓塞术在反复少量咯血患者中应用

目的探寻反复少量咯血患者行BAE治疗后疗效以及BA-CTA对少量咯血患者手术的指导作用。方法我院2017年1月至2019年6月收治的反复少量咯血患者123例,其中介入组65例,介入组57例术前行BA-CTA检查,对照组58例,统计介入组技术及临床成功率,并发症发生情况,比较BA-CTA与DSA血管检出情况,比较两组1年内的咯血复发率、大咯血率及95%CI。结果将BA-CTA与DSA检出血管数量作比较,P<0.05,获得BA-CTA的敏感度为96.7%,特异性为100%。介入组技术及临床成功率为100%。介入组复发率16.9%,其中大咯血率为1.5%,对照组复发率34.5%,其中大咯血率为10.3%,P<0.05,差异具有统计学意义。介入组95%(CI为0.076-0.263),对照组5%(CI为0.219-0.471),介入组相对对照组的RR值为0.387。介入组术后3例偶有胸痛,3例偶有背痛,1例排尿困难,经对症治疗缓解。结论术前行BA-CTA检查可帮助责任血管检出,对介入手术有指导作用,反复少量咯血患者行栓塞治疗可有效降低咯血复发率及大咯血率,但是仍需更多研究证实。     

Glubran2胶介入栓塞在肺癌咯血中的应用效果

目的探讨Glubran2胶介入栓塞在肺癌咯血中的应用效果。方法回顾性分析山东省新汶矿业集团莱芜中心医院2009—2012年期间采取姑息治疗的30例中晚期肺癌咯血患者的临床资料,均行Glubran2胶介入栓塞治疗。结果栓塞完成即刻造影,支气管动脉为其靶动脉,均于术中成功注胶,Glubran2胶血管内铸型良好。即刻止血23例,术后4 h止血7例。术后复发1例,无一例出现脊髓损伤、窒息等严重并发症。术后6、12及24个月随诊无咯血事件。结论 Glubran2胶介入栓塞治疗肺癌咯血创伤小、安全、止血率高、复发率低。     

继发性甲状旁腺功能亢进术后出血的原因及处理——附6例临床分析

目的分析继发性甲状旁腺功能亢进(SHPT)术后出血的临床特征及处理预防措施。方法该院2014-08~2017-08接受手术治疗SHPT患者100例,对其中6例发生术后出血患者的临床资料进行回顾性分析。结果6例患者中2例为皮瓣出血,2例为颈前静脉出血,2例为颈前肌肉出血。6例患者均给予相应的处理措施,均未出现窒息等严重后果,治愈后出院。结论围手术期积极处理所有可能导致术后出血的原因,在手术过程中仔细操作并在关闭切口前彻底的止血,是避免术后出血的关键。