CAJ | 학술논문

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.
목적 탐토미창흉선절제술술중출혈적처리급예방.방법 회고성분석52례미창흉선수술환자적병력자료,병중방록상,복습문헌.결과 50례환자중전시흉강경수술24례,체분기S궤기인흉선확대절제28례,무수술사망발생.l례궤기인수술환자술중출혈,봉합지혈.3례흉강경술중출혈,l례개위개방수술재체외순배보조하지혈,1례인지혈시봉합중심정맥도관,술후7d2차개흉취출.결론 미창흉선절제술출혈소견,응이예방위주.미창강경수술일단발생출혈,난이지혈,요과단개위개방수술,비자체혈회수혹보조순배,이보증안전.
Objective To study the management and prevention of bleeding during the thymectomy procedures.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 thoracoscopic 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 innominate 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.Prevention is more important than treatment.Thoracoscopic surgery should be converted to open surgery in case of bleeding and the mechanical circulatory support with an auxiliary circulating pump or intraoperative autotransfusion should be prepared.