Postoperative Hemorrhage after Pulmonary Resection
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Between January 1956 and the end of December 1966, we had 41 cases of unexpected major hemorrhage in the thorax after pulmonary resection. They represented 7.9 percent of a total of 517 cases of pulmonary resection, of the 41 cases, 27 underwent a total of 30 operations of rethoracotomy within 48 hours of their initial pulmonary resection. They were called as emergency thoracotomies, The patients ranged in age from 18 to 58, and consisted of 24 men and 3 women. With respect to operation types, an overwhelming proportion of the cases had resection in the right upper lobe, and seven had pneumonectomy.As for the blood pressure, which has much to do with the period of time before rethoracotomy and is an indicator of the patient's progress, many of the cases experienced blood pressure falls below 100mmHg, and eight of them were in shock.The source of postoperative hemorrhage was the thoracic wall in 10 of the cases, parenchymatous lung tissue in three, bronchial artery in one, intercostal artery in one, and the edge of a resected rib in one, whereas in fourteen cases the source could not be identified. Considering the causes of postoperative hemorrhage in connection with the observed thoracic wall adhesions, we found that such hemorrhage more often than not accompanied high degrees of adhesion, suggesting that the thoracic wall is most responsi ble.We have also studied these cases with respect to the incidence of postoperative hemorrhage in each type of operations as well as sucked blood, blood collecting in the thorax, total blood transfusion and other factors.The cases of emergency thoracotomy showed favorable results with respect to the postoperative breathing capacity when compared with cases of hematoma removal.There were no complications except for atelectasis noted in one of the cases, and there were no deaths.From these results we stress that operable cases should be subjected to rethoracotomy as soon as possible. With reference to operability, also, we consider that radiography as well as blood pressure, pulse, and other observations is an important means of determining the operability of a patient. Finally, a few suggestions to be followed in rethoracotomy are offered.
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
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