Maniwa Yoshimasa
Department of Thoracic Surgery, Kobe University, Kobe, Japan.
Kyobu Geka. 2017 Jul;70(8):688-691.
Postoperative intrathoracic hemorrhage is sometimes diagnosed in the thoracic cavity, while the patient is in the recovery room after undergoing thoracic surgery such as lung resection with thoracotomy or mediastinal surgery with a median sternotomy. The information from the chest tube is important to identify this kind of postoperative complication. When the condition becomes severe, the patient may develop hemorrhagic shock due to hemothorax and re-exploration to assess for bleeding and hemostasis may be required. The frequency of reoperation required in patients with postoperative hemorrhage is considered to be 1~3%. The bronchial artery, intercostal artery, and the intercostal vein are the most frequent sources of the hemorrhage. In some cases, the source of hemorrhage cannot be identified during re-exploration. However, intrathoracic hematoma removal by reoperation is essential to allow for adequate expansion of the remaining lung. Although a thoracoscope is usually inserted for re-exploration of the thoracic cavity initially, quick thoracotomy might be required to control hemorrhage, if the patient's vitals indicate rapid hemorrhage and subsequent shock.
术后胸腔内出血有时在胸腔手术（如开胸肺切除术或正中胸骨切开纵隔手术）后患者在恢复室时被诊断出来。胸管提供的信息对于识别这类术后并发症很重要。当病情严重时，患者可能因血胸而发生失血性休克，可能需要再次手术以评估出血情况并进行止血。术后出血患者所需再次手术的频率被认为是1%至3%。支气管动脉、肋间动脉和肋间静脉是最常见的出血来源。在某些情况下，再次手术时无法确定出血源。然而，通过再次手术清除胸腔内血肿对于使剩余肺充分扩张至关重要。虽然最初通常插入胸腔镜进行胸腔再次探查，但如果患者生命体征显示出血迅速并随后出现休克，则可能需要迅速开胸以控制出血。
