胸腺疾病微创术中出血的预防及处理

目的 探讨微创胸腺切除术术中出血的处理及预防.方法 回顾性分析52例微创胸腺手术患者的病历资料,并重放录相,复习文献.结果 50例患者中电视胸腔镜手术24例,达芬奇S机器人胸腺扩大切除28例,无手术死亡发生.l例机器人手术患者术中出血,缝合止血.3例胸腔镜术中出血,l例改为开放手术在体外循环辅助下止血,1例因止血时缝合中心静脉导管,术后7d2次开胸取出.结论 微创胸腺切除术出血少见,应以预防为主.微创腔镜手术一旦发生出血,难以止血,要果断改为开放手术,备自体血回输或辅助循环,以保证安全.

Prevention and treatment of bleeding during thymectomy procedures

Objective To study the management and prevention of bleeding during the thymectomy proce- dures. Methods Fifty-two patients with myasthenia gravis, with and without thymoma, were treated surgically. Results There were no intraoperative deaths. 50 thymectomies were performed completely using minimally invasive procedures （thoracoscopic or da Vinci S robotic）. One bleeding occurred with robotic and bleeding was stopped by suturing the torn vessel with robotic arms under the robotic camera vision without conversion. Three cases had thora- coscopic access： one bleeding was stopped by dress pressing; one case required conversion to open thoracotomy and had difficulties to stop bleeding and had to use the mechanical circulatory support with an auxiliary circulating pump ; one case had to be redone 7 days postoperatively in order to withdraw a catheter which indwelled the innomi- nate vein and it was sutured with the vessel wall together while stopping the bleeding during the surgical procedure. Conclusions Bleeding seldom occurres while the thymectomies are done either with thorocoscopic or robotic. Pre- vention is more important than treatment. Thoracoscopic surgery should be converted to open surgery in case of bleeding and the mechanical circulatory support with an auxihary circulating pump or intraoperative autotransfusion should be prepared.