Wu Yi-Cheng, Lu Ming-Shian, Yeh Chi-Hsiao, Liu Yun-Hen, Hsieh Ming-Ju, Lu Hung-I, Liu Hui-Ping
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chest. 2002 Nov;122(5):1844-7. doi: 10.1378/chest.122.5.1844.
Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgery practice. This study discusses the clinical aspects and utility of VATS in spontaneous hemopneumothorax (SHP).
Of 363 spontaneous pneumothorax (SP) cases, 24 patients presented with SHP (6.6%). The clinical features, surgical indications, emergency VATS technique, and patient outcomes are discussed.
All 24 patients were male (mean age, 25.3 years). Eleven patients were in hypovolemic shock, and their hemoglobin levels ranged from 6.7 to 12.7 g/dL; therefore, they received fluid resuscitation and blood transfusion. The amount of blood drained through the chest tube varied from 200 to 3,500 mL. Emergency VATS revealed that 5 cases were simple hemothoraces and 19 cases were associated with pneumothorax. The cause of bleeding was identified by thoracoscopy, as from an aberrant vessel (n = 11), torn parietal pleura (n = 4), ruptured vascularized bullae (n = 2), and lung parenchyma (n = 1). Six patients had no evidence of an obvious bleeding site. Bullous lesions were at the apex of the upper lobe in 14 patients, and multiple lobar involvement was seen in 2 patients. All the bullae were resected with endoscopic stapler in eight patients and ligated with a homemade endoloop in eight patients. The mean operation time was 42 min. The mean chest tube removal time was 3.5 days after insertion, and mean postoperative stay was 4.5 days. There is no recurrence of SHP or SP during the follow-up period.
SHP complicated by severe bleeding presents a potentially grave emergency. VATS may be considered as feasible treatment for patients with SHP.
电视辅助胸腔镜手术（VATS）在常规胸外科手术实践中发挥着重要作用。本研究探讨VATS在自发性血气胸（SHP）中的临床情况及应用价值。
在363例自发性气胸（SP）病例中，24例表现为SHP（6.6%）。讨论了其临床特征、手术指征、急诊VATS技术及患者预后。
24例患者均为男性（平均年龄25.3岁）。11例患者处于低血容量休克状态，血红蛋白水平在6.7至12.7 g/dL之间，因此接受了液体复苏和输血治疗。经胸腔引流管引出的血量在200至3500 mL之间。急诊VATS显示，5例为单纯血胸，19例合并气胸。通过胸腔镜确定出血原因，分别为异常血管（n = 11）、壁层胸膜撕裂（n = 4）、血管化肺大疱破裂（n = 2）和肺实质（n = 1）。6例患者未发现明显出血部位。14例患者的肺大疱病变位于上叶尖部，2例患者为多叶受累。8例患者使用内镜吻合器切除所有肺大疱，8例患者使用自制的内镜圈套器结扎。平均手术时间为42分钟。胸腔引流管平均拔除时间为置管后3.5天，术后平均住院时间为4.5天。随访期间未出现SHP或SP复发。
合并严重出血的SHP是一种潜在的严重急症。VATS可被视为SHP患者的可行治疗方法。
