Song In-Hag, Lee Seock Yeol, Lee Seung Jin, Choi Won Suk
Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University, Cheonan Hospital, 31, 6-gil, Soonchunhyang, Dongnam-gu, Chenan-si, Chungcheongnam-do, Cheonan, 31151, South Korea.
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea.
Gen Thorac Cardiovasc Surg. 2017 May;65(5):280-284. doi: 10.1007/s11748-017-0755-3. Epub 2017 Mar 10.
The aim of this study was to identify appropriate method of diagnosis and treatment of spontaneous pneumomediastinum (SPM) based on our experience.
The medical records of patients who were diagnosed with SPM and treated at our hospital between April 2006 and July 2015 were, retrospectively, analyzed. The data included characteristics of the patients, method of diagnosis, treatment and clinical course.
Forty-five patients were diagnosed with SPM and treated at our hospital. The mean age of patients was 18.96 ± 4.65 years and 35 patients were male. The main symptoms expressed by these patients were chest pain, throat pain or discomfort, and dyspnea. Nine patients had a precipitating event leading to SPM. Twelve patients had normal chest X-ray findings but were subsequently diagnosed with SPM on chest computed tomography (CT). Additional procedures including esophagogram (n = 36), bronchoscopy (n = 14) and endoscopy (n = 1) were done but none of patients were found to have organ damage. All patients received oxygen inhalation therapy. Oral intake was restricted in 36 patients and 43 patients received prophylactic antibiotics. The mean time taken for symptomatic improvement was 1.73 ± 0.85 days from diagnosis. The mean hospital stay was 3.93 ± 1.44 days and no patient developed recurrence of SPM during the follow-up period.
In addition to chest X-ray, chest CT is recommended for accurate diagnosis of SPM. However, further invasive investigations, restriction of oral intake and the use of prophylactic antibiotics have minimal role in the diagnosis and treatment of SPM.
基于我们的经验确定自发性纵隔气肿（SPM）的合适诊断和治疗方法。
回顾性分析2006年4月至2015年7月期间在我院诊断并治疗的SPM患者的病历。数据包括患者特征、诊断方法、治疗和临床过程。
45例患者在我院被诊断为SPM并接受治疗。患者的平均年龄为18.96±4.65岁，男性35例。这些患者的主要症状为胸痛、咽痛或不适以及呼吸困难。9例患者有导致SPM的诱发事件。12例患者胸部X线检查结果正常，但随后胸部计算机断层扫描（CT）诊断为SPM。进行了包括食管造影（n = 36）、支气管镜检查（n = 14）和内镜检查（n = 1）等额外检查，但未发现患者有器官损伤。所有患者均接受吸氧治疗。36例患者限制经口摄入，43例患者接受预防性抗生素治疗。从诊断开始症状改善的平均时间为1.73±0.85天。平均住院时间为3.93±1.44天，随访期间无患者发生SPM复发。
除胸部X线外，推荐使用胸部CT准确诊断SPM。然而，进一步的侵入性检查、限制经口摄入和使用预防性抗生素在SPM的诊断和治疗中作用极小。
