RESUMEN
Background: The patients with tuberculosis-destroyed lungs often have heavy adhesion in the affected side of the pleural cavity and abundant collateral circulation, which bring about considerable challenges to surgical treatment. Some patients with tuberculosis-destroyed lungs will have hemoptysis symptoms. In clinical work, we found that patients with hemoptysis before surgery due to hemoptysis through regional artery occlusion treatment often have less bleeding during surgery, and it is relatively easy to stop bleeding during surgery, and the operation time is short. This study mainly used retrospective comparative cohort studies to explore the clinical efficacy of combined surgical treatment after regional systemic artery embolization pretreatment of tuberculosis-destroyed lung and provides a basis for further optimizing the surgical treatment of tuberculosis-destroyed lung. Methods: From June 2021 to September 2022, 28 patients with tuberculosis-destroyed lungs who underwent surgery in our department from the same medical group were selected. The patients were divided into 2 groups according to whether regional arterial embolization was introduced before surgery. In the observation group (n=13), before surgery, all patients received arterial embolization in the target area for hemoptysis, and surgery was performed 24-48 h after embolization. In the control group (n=15), direct surgical treatment was performed without embolization. The factors including operation time, intraoperative blood loss, and postoperative complication rates were compared between the 2 groups to assess the value of regional artery embolization combined with surgery in the treatment of tuberculosis-destroyed lung. Results: There was no significant difference between the 2 groups in general condition and disease condition, including age, duration of disease, location of lesion, and operation method (P>0.05). The operation time in the observation group was shorter than that in the observation group (P<0.05), the amount of intraoperative bleeding in the observation group was lower than that in the control group (P<0.05). The incidence of postoperative complications including pulmonary infection, anemia, and hypoproteinemia in the observation group was lower than that in the control group (P<0.05). Conclusions: Regional arterial embolism preconditioning combined with surgical operation may reduce the risk of conventional surgical treatment, shorten the operation time, and reduce postoperative complications.
RESUMEN
BACKGROUND: Treatment of tuberculous-destroyed lung (TDL) with pleuropulmonary resection is challenging. Pulmonary hemorrhage is a frequent complication of this surgical procedure. Continuous efforts have been made to investigate clinical procedures that may reduce intraoperative bleeding effectively. In this study, we evaluated the feasibility and safety of regional arterial embolization before pleuropulmonary resection in patients with TDL. METHODS: The clinical data of 32 patients with TDL were retrospectively reviewed and analyzed. These patients were admitted to the hospital between July 2009 and November 2016. All of the patients had moderate to massive hemoptysis and received regional arterial embolization in affected areas. Then, these patients underwent pleuropulmonary resection within 1 week to 2 months after embolization. RESULTS: The results showed that 25 patients (78.1%) had bronchial artery, and all patients had non-bronchial systemic artery found in affected areas. Mild to moderate chest pain was reported in 6 patients, and fever was reported in 2 patients. Intraoperative blood loss during pleuropulmonary resection in patients who had received preoperative regional arterial embolization was 625.6 ± 352.6 ml. Duration of the operation was 120.3 ± 75.2 min. Bronchopleural fistulae and empyema were found in 3 cases (9.4%). CONCLUSION: Performance of regional arterial embolization before pleuropulmonary resection offers a safe and feasible option that reduces intraoperative blood loss and shortens operative time in patients with TDL.