Inafuku Kenji, Maehara Takamitsu, Yamamoto Taketsugu, Masuda Munetaka
Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
Asian Cardiovasc Thorac Ann. 2015 May;23(4):435-8. doi: 10.1177/0218492314568105. Epub 2015 Jan 22.
Although spontaneous hemopneumothorax is rare, emergency surgery may be necessary if massive bleeding is present.
We examined therapeutic strategies and outcomes as well as background factors in 16 patients with spontaneous hemopneumothorax treated at our hospital between April 2002 and August 2013.
Emergency surgery was performed in 3 patients, all of whom were hemodynamically unstable. Elective surgery was performed in 7 patients, all of whom showed continuous bleeding from a pleural cavity drain. The surgery consisted of intrapleural hematoma removal, hemostasis, and bullectomy; 3-port thoracoscopy was used in all of the surgical cases. Six patients, none of whom showed continuous bleeding, recovered with conservative therapy. Comparing the conservative therapy and surgery groups revealed the mean continuous bleeding volume and total blood loss to be significantly greater in the latter, but no significant difference was noted between the two groups in terms of the initial bleeding volume following tube thoracostomy. None of the cases required a blood transfusion.
Spontaneous hemopneumothorax is not necessarily an indication for surgery, and even when the initial volume of blood drained through the chest tube is large, some patients can still be treated conservatively with careful monitoring of vital signs and continuous bleeding volumes. However, it is important not to miss the optimal timing of surgery in order to avoid administering unnecessary blood transfusions to young patients.
虽然自发性血气胸很少见，但如果出现大量出血，可能需要进行急诊手术。
我们研究了2002年4月至2013年8月间在我院接受治疗的16例自发性血气胸患者的治疗策略、治疗结果以及相关背景因素。
3例患者接受了急诊手术，所有患者血流动力学均不稳定。7例患者接受了择期手术，所有患者均表现为胸腔引流管持续出血。手术包括清除胸腔内血肿、止血和肺大疱切除术；所有手术病例均采用三孔胸腔镜手术。6例患者未出现持续出血，经保守治疗后康复。保守治疗组与手术组比较，手术组的平均持续出血量和总失血量显著更大，但两组在胸腔闭式引流术后的初始出血量方面无显著差异。所有病例均未输血。
自发性血气胸不一定需要手术治疗，即使通过胸管引流的初始出血量很大，一些患者仍可通过密切监测生命体征和持续出血量进行保守治疗。然而，重要的是不要错过最佳手术时机，以免给年轻患者输注不必要的血液。
