Kim Eung-Soo, Kang Jong-Yael, Pyo Chang-Hae, Jeon Eui-Yong, Lee Whan-Bong
Department of Thoracic and Cardiovascular Surgery, Hanil General Hospital, KEPCO Medical Foundation, Seoul, Korea.
Ann Thorac Cardiovasc Surg. 2008 Jun;14(3):149-53.
Spontaneous hemopneumothorax is a rare clinical disorder that results from a torn small vessel located in adhesions between the visceral and parietal pleurae resulting from the progress of lung collapse. A large spontaneous hemopneumothorax is often life threatening, so the late recognition and delayed intervention can increase mortality rate.
From March 1994 to February 2006, a total of 983 patients were treated with spontaneous pneumothorax. Seventeen (1.7%) developed spontaneous hemopneumothorax. We analyzed many factors such as sex and age distribution, affected site, clinical symptoms, bleeding volume, causes, treatments, complications, and others.
All 17 patients were males between the ages of 16 and 33 with the average being 19.5 years, except for 1 patient who was 60 years old. In all patients, it was the first occurrence of pneumothorax. Thirteen patients had a history of smoking (76.5%, average 8.6 pack-years). The amount of bleeding ranged from 450 to 2,900 mL (average 1,308.8 mL). Eight patients were given a homologous blood transfusion. In all patients, the cause of hemopneumothorax was a torn pleural adhesion band. All patients were treated with the closed thoracostomy; five were treated with only the closed thoracostomy, and the other 12 were treated by the thoracostomy combined with video-assisted thoracic surgery (VATS) or thoracotomy. One patient, who had had a thoracotomy, needed an exploratory thoracotomy because of a trapped lung after 1 week.
We are reporting 17 patients with spontaneous hemopneumothorax to emphasize the following: (i) the mechanism of spontaneous hemopneumothorax, which was caused by a torn pleural adhesion band resulting from the lung collapse. The collapse was developed mainly by an air leak from ruptured bullae, and rarely by additional pressure from the outside during a drainage procedure. (ii) The importance of early recognition and prompt surgical intervention by VATS or thoracotomy. We preferred VATS to thoracotomy because it is easier to access the bleeding point near the Sibson's fascia by VATS, and it can reduce the loss of blood by relatively shorter operating time.
自发性血气胸是一种罕见的临床病症，由肺萎陷进展导致脏层胸膜与壁层胸膜粘连处的小血管撕裂引起。大量自发性血气胸常危及生命，因此晚期识别和延迟干预会增加死亡率。
1994年3月至2006年2月，共有983例患者接受自发性气胸治疗。其中17例（1.7%）发生了自发性血气胸。我们分析了许多因素，如性别和年龄分布、受累部位、临床症状、出血量、病因、治疗方法、并发症等。
17例患者均为男性，年龄在16至33岁之间，平均19.5岁，只有1例患者为60岁。所有患者均为首次发生气胸。13例患者有吸烟史（76.5%，平均8.6包年）。出血量在450至2900毫升之间（平均1308.8毫升）。8例患者接受了同种异体输血。所有患者血气胸的病因均为胸膜粘连带撕裂。所有患者均接受了胸腔闭式引流术；5例仅接受胸腔闭式引流术治疗，另外12例接受了胸腔闭式引流术联合电视辅助胸腔手术（VATS）或开胸手术治疗。1例接受开胸手术的患者在1周后因肺陷闭需要进行探查性开胸手术。
我们报告了17例自发性血气胸患者，以强调以下几点：（i）自发性血气胸的机制，是由肺萎陷导致的胸膜粘连带撕裂引起。萎陷主要由破裂肺大疱漏气所致，引流过程中很少由外部额外压力引起。（ii）早期识别及通过VATS或开胸手术进行及时手术干预的重要性。我们更倾向于VATS而非开胸手术，因为通过VATS更容易接近奇静脉弓附近的出血点，且相对较短的手术时间可减少失血。
