Clark Gregory, Licker Marc, Bertin Daniel, Spiliopoulos Anastase
Centre Hospitalier du Centre du Valais, Sion, Switzerland.
Eur J Cardiothorac Surg. 2007 Mar;31(3):566-8. doi: 10.1016/j.ejcts.2006.12.010. Epub 2007 Jan 9.
We report a case of a massive haemothorax following bilateral surgical resection of apical bullae. Occult bleeding was not recognized until the onset of a life-threatening circulatory collapse associated with metabolic acidosis and a fall in haemoglobin level. Using a thoracotomy, large amounts of blood were evacuated from the thoracic cavity and bleeding originating from ruptured pleural adhesion was easily controlled. Thrombotic material with talc particles was found to obstruct the 19-French 4-channel Blake drain. Although this new silastic Blake tube has been recommended in cardiac surgical patients, extending its indication in thoracic surgery, particularly when talc pleurodesis is used, should be questioned given the enhanced postoperative prothrombotic state and risk of drain obstruction. In conclusion, caution should be exercised when new small-sized material is introduced in clinical practice, especially after talc pleurodesis following thoracic surgery.
我们报告一例双侧肺尖大疱手术切除后发生大量血胸的病例。直到出现与代谢性酸中毒和血红蛋白水平下降相关的危及生命的循环衰竭时，隐匿性出血才被发现。通过开胸手术，从胸腔抽出了大量血液，源自破裂胸膜粘连的出血很容易得到控制。发现血栓物质与滑石颗粒阻塞了19号法国4通道布雷克引流管。尽管这种新型硅橡胶布雷克管已被推荐用于心脏手术患者，但鉴于术后血栓形成状态增强和引流管阻塞风险，将其适应证扩展到胸外科手术，尤其是在使用滑石粉胸膜固定术时，值得质疑。总之，在临床实践中引入新型小尺寸材料时应谨慎，尤其是在胸外科手术后进行滑石粉胸膜固定术后。
