Table 4_Intrapleural hemocoagulase Bothrops atrox and early outcomes after VATS for stage IA non-small cell lung cancer.docx

BackgroundHemocoagulase Bothrops atrox (HBA) is used to reduce surgical bleeding, but its impact on postoperative coagulation after video-assisted thoracoscopic surgery (VATS) remains unclear. We evaluated the effects of intrapleural HBA on coagulation profiles and early recovery in stage IA non-small cell lung cancer (NSCLC).
MethodsWe retrospectively analyzed 442 stage IA NSCLC patients undergoing VATS, allocated to HBA (n = 92) or non-HBA (n = 350) groups. The primary outcome was postoperative coagulation; secondary outcomes were length of stay and postoperative complications. Baseline characteristics were balanced using inverse probability of treatment weighting (IPTW), followed by multivariable analyses.
ResultsAfter IPTW adjustment, intrapleural HBA was associated with a longer prothrombin time (PT; 12.83 ± 0.99 vs. 12.31 ± 1.50 s; β = 0.28, 95% CI 0.11–0.45, p = 0.001) and lower fibrinogen (FIB) levels (322.06 ± 96.68 vs. 353.52 ± 122.65 mg/dL; β = −33.33, 95% CI − 48.46 to −18.20, p < 0.001), while activated partial thromboplastin time and thrombin time did not differ significantly. In the IPTW-weighted cohort, HBA use was associated with a lower incidence of postoperative complications (6.5% vs. 12.0%; OR = 0.35, 95% CI 0.19–0.63, p = 0.001) and a shorter postoperative hospital stay (β = −2.06, 95% CI − 2.61 to −1.50, p < 0.001).
ConclusionIntrapleural HBA injection in stage IA NSCLC undergoing VATS is associated with modest alterations in coagulation (prolonged PT and reduced FIB) and improved early outcomes, including fewer complications and shorter hospitalization. Prospective studies are warranted to confirm these findings.

【背景】矛头蝮蛇血凝酶（Hemocoagulase Bothrops atrox, HBA）常用于减少手术出血，但其对电视辅助胸腔镜手术（video-assisted thoracoscopic surgery, VATS）后患者凝血功能的影响尚不清楚。本研究旨在评估胸膜腔内注射HBA对IA期非小细胞肺癌（non-small cell lung cancer, NSCLC）患者凝血指标及早期康复的影响。
【方法】本研究回顾性分析了442例接受电视辅助胸腔镜手术的IA期非小细胞肺癌患者，将其分为HBA组（n=92）与非HBA组（n=350）。本研究的主要结局为术后凝血功能情况，次要结局为住院时长与术后并发症发生率。采用治疗加权逆概率（inverse probability of treatment weighting, IPTW）均衡基线特征，随后进行多变量分析。
【结果】经IPTW校正后，胸膜腔内注射HBA可延长凝血酶原时间（prothrombin time, PT：12.83±0.99 vs 12.31±1.50 s；β=0.28，95%CI 0.11~0.45，p=0.001）并降低纤维蛋白原（fibrinogen, FIB：322.06±96.68 vs 353.52±122.65 mg/dL；β=-33.33，95%CI -48.46~-18.20，p<0.001），而活化部分凝血活酶时间与凝血酶时间无显著差异。在IPTW加权队列中，使用HBA与更低的术后并发症发生率（6.5% vs 12.0%；OR=0.35，95%CI 0.19~0.63，p=0.001）及更短的术后住院时长（β=-2.06，95%CI -2.61~-1.50，p<0.001）相关。
【结论】接受电视辅助胸腔镜手术的IA期非小细胞肺癌患者行胸膜腔内注射HBA，可引起凝血功能的轻度改变（凝血酶原时间延长、纤维蛋白原水平降低），并改善早期康复结局，包括减少术后并发症及缩短住院时长。未来需开展前瞻性研究以验证本研究结果。