Rashid M A, Wikström T, Ortenwall P
Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg University, Sweden.
J Trauma. 2000 Aug;49(2):286-90. doi: 10.1097/00005373-200008000-00016.
Extrapleural hematoma has been found mostly in single case reports as diagnoses with different names. Although huge extrapleural hematoma can cause ventilatory and circulatory disturbances and even death, it has received almost no attention in the literature. Certain basic and modern facts need to be clarified regarding the definition, classification, and significance of extrapleural hematoma in the practice of chest trauma.
A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity, and mortality of patients with chest trauma and a documented extrapleural hematoma.
The incidence of traumatic extrapleural hematoma was 34 of 477, 7.1%. The incidence of thoracic lesions was 86 of 34 = 2.5 lesions per patient, whereas the incidence of extrathoracic lesions was 30 of 34 = 0.9 lesions per patient. Associated rib fractures were found in 30 of 34, 88.2%. More than half of the patients had an associated hemothorax. A thoracotomy was used successfully to remove a huge hematoma in one patient.
Extrapleural hematoma has been found to be more common than previously reported. Nomenclature and classification are suggested. One of the common injuries to the chest, particularly rib fracture, hemothorax, lung contusion, or pneumothorax might provide the surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated extrapleural hematoma. A formal or mini-thoracotomy is the recommended procedure in cases of huge hematomas.
胸膜外血肿大多在个案报告中被发现，诊断名称各异。尽管巨大的胸膜外血肿可导致通气和循环障碍甚至死亡，但在文献中几乎未受到关注。在胸部创伤实践中，关于胸膜外血肿的定义、分类及意义的某些基本和现代事实需要阐明。
进行了一项为期10年的回顾性研究，以分析有记录的胸膜外血肿的胸部创伤患者的发病率、诊断、治疗、发病率和死亡率。
创伤性胸膜外血肿的发病率为477例中的34例，即7.1%。胸部病变的发病率为34例中的86处，即每位患者2.5处病变，而胸外病变的发病率为34例中的30处，即每位患者0.9处病变。34例中有30例（88.2%）发现有肋骨骨折。超过一半的患者伴有血胸。成功地通过开胸手术为一名患者清除了巨大血肿。
已发现胸膜外血肿比先前报道的更为常见。建议采用命名法和分类。胸部常见损伤之一，尤其是肋骨骨折、血胸、肺挫伤或气胸，可能会为外科医生提供可靠的临床线索，提示患者有发生相关胸膜外血肿的极高风险。对于巨大血肿病例，推荐采用正式开胸手术或小切口开胸手术。
