Lim Ah Leum, Kim Cheol-Hong, Hwang Yong Il, Lee Chang Youl, Choi Jeong-Hee, Shin Taerim, Park Yong-Bum, Jang Seung-Hun, Park Sang Myeon, Kim Dong-Gyu, Lee Myung Goo, Hyun In-Gyu, Jung Ki-Suck, Shin Ho-Seung
Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
Tuberc Respir Dis (Seoul). 2012 May;72(5):441-7. doi: 10.4046/trd.2012.72.5.441. Epub 2012 May 29.
Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.
Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.
A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).
Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.
胸腔闭式引流（CTD）是治疗气胸、血胸的一种手段，也用于胸外科手术后。但是，在肺扩张不全和/或CTD持续漏气的情况下，应考虑进行内科或外科胸腔镜检查，若无法进行，则考虑有限开胸手术。我们评估了支气管镜注射乙醇胺控制CTD患者持续漏气的疗效。
连续纳入CTD持续或长期漏气的患者。我们通过纤维支气管镜用注射针将1.0 mL 5%油酸乙醇胺溶液直接注入亚段或其远端支气管，此处可能是漏气部位，注射1至21次。
共纳入15例患者；14例自发性气胸[特发性9例、慢性阻塞性肺疾病（COPD）3例、肺结核后2例]，1例脓胸合并支气管胸膜瘘。其中，5例是外科治疗（肺大疱或肺气囊楔形切除并折叠缝合）后CTD持续漏气的患者。乙醇胺注射治疗后，12例成功，但3例（特发性、COPD和肺结核后）失败，随后2例行手术治疗，1例行胸膜固定术。出现了一些不良反应，如发热、胸痛和影像学上的渗出增加，但均短暂出现且未进一步发展而缓解。治疗成功后，从治疗到出院的时间约为3天（中位数）。
支气管镜乙醇胺注射治疗可能对控制CTD患者的漏气及缩短住院时间有一定作用。
