Tay Cheong Kiat Julian, Yee Yong Chen, Asmat Atasha
Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, Singapore.
Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, Singapore
Asian Cardiovasc Thorac Ann. 2015 Mar;23(3):308-10. doi: 10.1177/0218492314561502. Epub 2014 Nov 18.
Spontaneous hemopneumothorax is rare, accounting for only 1%-12% of patients presenting with spontaneous pneumothorax. The optimal management of these patients remains controversial with no definitive guidelines on patient selection and timing of surgery. The aim of this study was to review our institution's surgical experience in the management of patients with spontaneous hemopneumothorax.
We performed a retrospective review of all patients with spontaneous hemopneumothorax who underwent surgery from January 2000 to June 2013. Patient data were obtained from our institution's primary spontaneous pneumothorax database.
Of 510 patients who underwent surgery for spontaneous pneumothorax, 33 (6.4%) developed spontaneous hemopneumothorax. The mean age was 24.0 years (range 16-40 years). In 30 (90.9%) patients, it was their first presentation of pneumothorax. There were 25 (75.8%) patients with Vanderschueren stage III spontaneous pneumothorax. Blood loss ranged from 250 to 3000 mL (mean 1280 mL). In 28 patients, a torn adhesion band was the source of bleeding. Thoracotomy was the surgical approach in 9 (27.3%) patients, and video-assisted thoracic surgery was used in 24 (72.7%). One patient required reoperation for retained clots. There was no mortality.
Our results suggest that surgical management of spontaneous hemopneumothorax can be undertaken with minimal morbidity and mortality. With the increasing use of video-assisted thoracic surgery, definitive surgical management of spontaneous hemopneumothorax can be instituted earlier.
自发性血气胸较为罕见，仅占自发性气胸患者的1% - 12%。这些患者的最佳治疗方案仍存在争议，在患者选择和手术时机方面尚无明确的指导原则。本研究的目的是回顾我院在自发性血气胸患者治疗方面的手术经验。
我们对2000年1月至2013年6月期间所有接受手术治疗的自发性血气胸患者进行了回顾性研究。患者数据来自我院的原发性自发性气胸数据库。
在510例接受自发性气胸手术的患者中，33例（6.4%）发生了自发性血气胸。平均年龄为24.0岁（范围16 - 40岁）。30例（90.9%）患者为首次发生气胸。25例（75.8%）患者为范德舒伦III期自发性气胸。失血量在250至3000毫升之间（平均1280毫升）。28例患者中，出血源为撕裂的粘连带。9例（27.3%）患者采用开胸手术，24例（72.7%）患者采用电视辅助胸腔镜手术。1例患者因残留血凝块需要再次手术。无死亡病例。
我们的结果表明，自发性血气胸的手术治疗可使发病率和死亡率降至最低。随着电视辅助胸腔镜手术的应用增加，自发性血气胸的确定性手术治疗可更早实施。
