[Strategies for the prevention and control of bleeding due to vascular injury in thoracoscopic lung surgery]

The technique of thoracoscopic lung surgery has gradually matured. Nowadays, thoracoscope is recommended as the most preferred approach for surgical treatment of early stage non-small cell lung cancer in different guidelines. However, there are still some cases of accidential major bleeding due to vascular injury during thoracoscopic lung surgery. The wall of the hilum vessels is relatively thin. These vessels often involve a great portion of the cardiac output blood flow. Once the injury happened, the emergent condition may be life-threatening due to massive blood loss. Therefore, this became an important factor which hindered the development of thoracoscopic lung surgery. In this review, details of the vascular injury in thoracoscopic lung surgery were summarized, including the incidence of vascular injury, commonly injured sites and reasons of the injuries. Among all the cases of thoracoscopic major pulmonary resection, 2.9% to 9.2% may suffer from vascular injury during the operation. The most commonly injuried sites are pulmonary artery and the branches, and this is also the most critical situation during thoracoscopic lung surgery. Hilum adhesion is the most important risk factor for vascular injury. On the one hand, the suction-compressing angiorrhaphy technique was developed for bleeding control and angioplasty. On the other hand, the strategies like pre-control of the pulmonary, cut the bronchus in advance, and fire the bronchus and pulmonary artery together may decrease the incidence of vascular injury in patients with risk factors.胸腔镜肺外科技术已逐渐成熟，国内外指南均推荐首选胸腔镜进行早期肺癌的外科治疗。尽管如此，胸腔镜肺手术仍偶有大血管损伤出血等意外情况发生。肺门血管壁薄，且紧邻心脏，血流量大，一旦损伤出血，往往较为危急，甚至可能危及患者生命，是阻碍胸腔镜肺外科手术发展的重要因素。本文对胸腔镜肺手术中血管损伤出血的发生情况、易于出现损伤的部位及其原因等进行了总结。国内外文献报道中，胸腔镜肺手术中血管损伤出血发生率为2.9%～9.2%，其中以肺动脉及其分支损伤最为常见，也最为危急，肺门结构粘连是导致血管损伤出血的重要因素。术中可通过胸腔镜吸引－侧压止血技术控制出血，并完成血管修补；对于高危患者，采用肺动脉预阻断、支气管预切断、支气管肺动脉同切等策略可有效预防血管损伤的发生。.