Evaluation and management of thoracic cavity hemorrhage during general thoracic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAO Huihui , XIAO Xi ,  MENG Hui

Department of Thoracic Surgery, Hospital of Lanzhou Army, Lanzhou, 730050, P.R.China;

Corresponding?author：

MENG Hui, Email: mhgl2008@163.com

Keywords：

General thoracic surgery; postoperative hemorrhage; hemostasis; blood transfusions; complication; enhanced recovery after surgery

DOI：

10.7507/1007-4848.201604065

Video：

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Postoperative bleeding and coagulation hemothorax is the primary cause for re-operation after general thoracic surgical procedures. We should do a good job in the assessment of preoperative factors to increase the operation control. This article mainly introduces the thoracic surgery bleeding quantitative assessment, bleeding location and cause, hemostasis, transfusion trigger, pleural drainage tube selection, surgical complications, enhanced recovery after surgery and so on.

Citation： CAO Huihui, XIAO Xi, MENG Hui. Evaluation and management of thoracic cavity hemorrhage during general thoracic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 640-644. doi: 10.7507/1007-4848.201604065 Copy

1.	Foroulis CN, Kleontas A, Karatzopoulos A. Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures. J Thorac Dis, 2014, 6(Suppl 1): S21-31.
2.	Biere SS, Maas KW, Bonavina L, et al. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg, 2011, 11: 2.
3.	Sosa CG, Althabe F, Belizan JM, et al. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obst Gynecol, 2009, 113(6): 1313-1319.
4.	陳錚立, 李建榮, 王樹超, 等. 神經外科手術出血量的統計分析和輸血策略. 中國輸血雜志, 2014, 27(4): 400-402.
5.	Lang DL, Zhao FL, Robertson J. Prevention of postpartum haemorrhage: cost consequences analysis of misoprostol in low-resource settings. BMC Pregnancy Childbirth, 2015, 23(15): 305.
6.	張高峰, 孫戰文. 普胸外科術后二次開胸止血 19 例體會. 中國現代手術學雜志, 2014, 18(6): 457-459.
7.	茆勇, 應佑國. ICU 食管癌術后肺部并發癥的臨床調查研究. 現代腫瘤醫學, 2015, 23(21): 3081-3083.
8.	謝琴, 莫占端, 華潤, 等. 老年食管癌患者術后肺部感染影響因素與預防干預研究. 中華醫院感染學雜志, 2016, 26(2): 346-348.
9.	Schweigert M, Solymosl N, Dubecz A, et al. Emergency oesophagectomy for oesophageal perforation after chemoradiotherapy for oesophageal cancer. Ann Roy Coll Surg Eng, 2015, 97(2): 140-145.
10.	Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus april 2012 edited by the Japan Esophageal Society. Esophagus, 2012, 379(9829): 1887-1892.
11.	丁凱, 周曉燕, 唐春立, 等. 15 例普通胸外科術后患者胸腔內出血部位、原因及處理. 山東醫藥, 2013, 53(27): 58-59.
12.	蘇志勇, 張鐿鐳, 姜天爍, 等. 電視胸腔鏡手術中控制出血的技術方法. 中國胸心血管外科臨床雜志, 2013, 20(2): 244-246.
13.	Singla S, Sachdeva R, Uertsky BF. The risk of adverse cardiac and bleeding events following noncardiac surgery relative to antiplatelet therapy in patients with prior percutaneous coronary intervention. J Am Coll Cardiol, 2012, 60(20): 2005-2020.
14.	李永博. 術中噴灑凝血酶對開胸手術術后引流的影響. 河北: 河北醫科大學, 2014.
15.	仲照奎. 普胸外科術后血胸的手術處理探討. 中國現代藥物應用, 2016, 10(1): 92-93.
16.	Plaksin SA, Petrov ME. Early rethoracotomies for diseases and chest traumas. Vestnik khirurgii imeni ⅡGrekova, 2012, 171(5): 20-22.
17.	Parshin VD, BiriukovI IuV, Gudovskii AM, et al. Rethoracotomy in thoracic surgery. Khirurgiia, 2012, (5): 4-9.
18.	Ermolov AS, Stonogin VD. Rethoracotomy because of hemorrhage in the early postoperative period after operations on the lungs and mediastinal organs. Vestnik khirurgii imeni ⅡGrekova, 1996, 155(3): 67-70.
19.	Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Inter Med, 2012, 157(1): 49-58.
20.	廖刃, 劉進. 華西圍術期輸血指征評分——以臨床需求為目標的輸血評分. 中國胸心血管外科臨床雜志, 2014, 21(2): 145-146.
21.	魏新廣, 管玉龍. 優化圍術期血液管理. 中國胸心血管外科臨床雜志, 2016, 23(4): 390-394.
22.	Weltert L, Rondinelli B, Bello R, et al. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion, 2015, 55(7): 1644-1654.
23.	馬丹, 楊梅, 樊駿, 等. 胸腔鏡肺葉切除術后引流管管徑對患者舒適度影響的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 928-931.
24.	韓兆杰, 宋志芳, 蘇建華, 等. 單胸腔引流管在肺癌術后快速康復中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 7-11.
25.	楊梅, 樊駿, 周紅霞, 等. 胸腔鏡肺癌肺葉切除術后 16F 較 28F 胸腔引流管應用的臨床優勢. 中國肺癌雜志, 2015, 18(8): 512-518.
26.	張德明, 趙金平. 兩種胸腔引流方式在肺葉切除術后患者中應用的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(2): 156-159.
27.	何哲浩, 楊運海, 張翀. 達芬奇機器人胸部手術后優化胸腔引流策略的初步探索. 中國胸心血管外科臨床雜志, 2015, 22(10): 919-922.
28.	魏寧, 藺瑞江, 胡文騰, 等. 頸部與胸部吻合對食管癌術后并發癥影響的系統評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2016, 23(1): 50-54.
29.	Phillips B R. Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions. Open Access Surg, 2016, 9(5): 5-14.
30.	Hellan M, Spinoglio G, Pigazzi A. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc, 2014, 28(5): 1695-1702.
31.	Protyniak B, Dinallo AM, Boyan WP Jr, et al. Intraoperative indocyanine green fluorescence angiography-an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg, 2015, 81(6): 580-584.
32.	文玉琴, 何麗, 李麗霞. 胸腹腔鏡聯合食管癌根治術患者感染預防與控制研究. 中華醫院感染學雜志, 2016, 26(1): 98-100.
33.	Biere SS, Van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet (London, England), 2012, 379(9829): 1887-1892.
34.	張睿, 史敏科, 王小雨. 不同濃度羅哌卡因肋間神經阻滯在開胸手術后早期鎮痛中的應用. 臨床麻醉學雜志, 2015, 31(4): 323-327.
35.	何建冰, 段紅兵, 康健樂. 改良肋間神經冷凍術在胸部術后鎮痛中應用的隨機對照研究. 中國胸心血管外科臨床雜志, 2016, 23(1): 34-40.
36.	任光國, 周允中, 主編. 胸外科手術并發癥的預防和治療. 北京: 人民衛生出版, 2004. 158-160.
37.	馬洪升, 程南生, 朱濤, 等. 華西醫院日間手術快速康復(ERAS)規范. 中國胸心血管外科臨床雜志, 2016, 23(2): 104-109.
38.	Holbek BL, Horsleben Petersen R, Kehlet H, et al. Fast-track video-assisted thoracoscopic surgery: future challenges. SCJ, 2016, 50(2): 78-82.

1. Foroulis CN, Kleontas A, Karatzopoulos A. Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures. J Thorac Dis, 2014, 6(Suppl 1): S21-31.
2. Biere SS, Maas KW, Bonavina L, et al. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg, 2011, 11: 2.
3. Sosa CG, Althabe F, Belizan JM, et al. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obst Gynecol, 2009, 113(6): 1313-1319.
4. 陳錚立, 李建榮, 王樹超, 等. 神經外科手術出血量的統計分析和輸血策略. 中國輸血雜志, 2014, 27(4): 400-402.
5. Lang DL, Zhao FL, Robertson J. Prevention of postpartum haemorrhage: cost consequences analysis of misoprostol in low-resource settings. BMC Pregnancy Childbirth, 2015, 23(15): 305.
6. 張高峰, 孫戰文. 普胸外科術后二次開胸止血 19 例體會. 中國現代手術學雜志, 2014, 18(6): 457-459.
7. 茆勇, 應佑國. ICU 食管癌術后肺部并發癥的臨床調查研究. 現代腫瘤醫學, 2015, 23(21): 3081-3083.
8. 謝琴, 莫占端, 華潤, 等. 老年食管癌患者術后肺部感染影響因素與預防干預研究. 中華醫院感染學雜志, 2016, 26(2): 346-348.
9. Schweigert M, Solymosl N, Dubecz A, et al. Emergency oesophagectomy for oesophageal perforation after chemoradiotherapy for oesophageal cancer. Ann Roy Coll Surg Eng, 2015, 97(2): 140-145.
10. Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus april 2012 edited by the Japan Esophageal Society. Esophagus, 2012, 379(9829): 1887-1892.
11. 丁凱, 周曉燕, 唐春立, 等. 15 例普通胸外科術后患者胸腔內出血部位、原因及處理. 山東醫藥, 2013, 53(27): 58-59.
12. 蘇志勇, 張鐿鐳, 姜天爍, 等. 電視胸腔鏡手術中控制出血的技術方法. 中國胸心血管外科臨床雜志, 2013, 20(2): 244-246.
13. Singla S, Sachdeva R, Uertsky BF. The risk of adverse cardiac and bleeding events following noncardiac surgery relative to antiplatelet therapy in patients with prior percutaneous coronary intervention. J Am Coll Cardiol, 2012, 60(20): 2005-2020.
14. 李永博. 術中噴灑凝血酶對開胸手術術后引流的影響. 河北: 河北醫科大學, 2014.
15. 仲照奎. 普胸外科術后血胸的手術處理探討. 中國現代藥物應用, 2016, 10(1): 92-93.
16. Plaksin SA, Petrov ME. Early rethoracotomies for diseases and chest traumas. Vestnik khirurgii imeni ⅡGrekova, 2012, 171(5): 20-22.
17. Parshin VD, BiriukovI IuV, Gudovskii AM, et al. Rethoracotomy in thoracic surgery. Khirurgiia, 2012, (5): 4-9.
18. Ermolov AS, Stonogin VD. Rethoracotomy because of hemorrhage in the early postoperative period after operations on the lungs and mediastinal organs. Vestnik khirurgii imeni ⅡGrekova, 1996, 155(3): 67-70.
19. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Inter Med, 2012, 157(1): 49-58.
20. 廖刃, 劉進. 華西圍術期輸血指征評分——以臨床需求為目標的輸血評分. 中國胸心血管外科臨床雜志, 2014, 21(2): 145-146.
21. 魏新廣, 管玉龍. 優化圍術期血液管理. 中國胸心血管外科臨床雜志, 2016, 23(4): 390-394.
22. Weltert L, Rondinelli B, Bello R, et al. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion, 2015, 55(7): 1644-1654.
23. 馬丹, 楊梅, 樊駿, 等. 胸腔鏡肺葉切除術后引流管管徑對患者舒適度影響的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 928-931.
24. 韓兆杰, 宋志芳, 蘇建華, 等. 單胸腔引流管在肺癌術后快速康復中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 7-11.
25. 楊梅, 樊駿, 周紅霞, 等. 胸腔鏡肺癌肺葉切除術后 16F 較 28F 胸腔引流管應用的臨床優勢. 中國肺癌雜志, 2015, 18(8): 512-518.
26. 張德明, 趙金平. 兩種胸腔引流方式在肺葉切除術后患者中應用的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(2): 156-159.
27. 何哲浩, 楊運海, 張翀. 達芬奇機器人胸部手術后優化胸腔引流策略的初步探索. 中國胸心血管外科臨床雜志, 2015, 22(10): 919-922.
28. 魏寧, 藺瑞江, 胡文騰, 等. 頸部與胸部吻合對食管癌術后并發癥影響的系統評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2016, 23(1): 50-54.
29. Phillips B R. Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions. Open Access Surg, 2016, 9(5): 5-14.
30. Hellan M, Spinoglio G, Pigazzi A. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc, 2014, 28(5): 1695-1702.
31. Protyniak B, Dinallo AM, Boyan WP Jr, et al. Intraoperative indocyanine green fluorescence angiography-an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg, 2015, 81(6): 580-584.
32. 文玉琴, 何麗, 李麗霞. 胸腹腔鏡聯合食管癌根治術患者感染預防與控制研究. 中華醫院感染學雜志, 2016, 26(1): 98-100.
33. Biere SS, Van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet (London, England), 2012, 379(9829): 1887-1892.
34. 張睿, 史敏科, 王小雨. 不同濃度羅哌卡因肋間神經阻滯在開胸手術后早期鎮痛中的應用. 臨床麻醉學雜志, 2015, 31(4): 323-327.
35. 何建冰, 段紅兵, 康健樂. 改良肋間神經冷凍術在胸部術后鎮痛中應用的隨機對照研究. 中國胸心血管外科臨床雜志, 2016, 23(1): 34-40.
36. 任光國, 周允中, 主編. 胸外科手術并發癥的預防和治療. 北京: 人民衛生出版, 2004. 158-160.
37. 馬洪升, 程南生, 朱濤, 等. 華西醫院日間手術快速康復(ERAS)規范. 中國胸心血管外科臨床雜志, 2016, 23(2): 104-109.
38. Holbek BL, Horsleben Petersen R, Kehlet H, et al. Fast-track video-assisted thoracoscopic surgery: future challenges. SCJ, 2016, 50(2): 78-82.

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