Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
BMC Surg. 2022 Jun 27;22(1):247. doi: 10.1186/s12893-022-01696-8.
Video-assisted thoracoscopic surgery (VATS) is an emerging technology in minimally invasive surgery, which has become recognized as standard treatments for early-stage lung cancer. Microcoil localization is considered to be a safe and effective way of preoperative localization, and is essential to facilitate VATS wedge-resection for lung nodules.
Here we report a rare case of a 28-year-old female who developed hemorrhagic shock caused by delayed pneumothorax after preoperative computed tomography (CT)-guided microcoil localization. The thoracic CT revealed hydropneumothorax in the right thoracic cavity at 10 h after microcoil localization, and the patient later had significant decreased hemoglobin level (87 g/L). Emergency thoracoscopic exploration demonstrated that the hemorrhagic shock was induced by delayed pneumothorax, which led to the fracture of an adhesive pleura cord and an aberrant vessel. Electrocoagulation hemostasis was then performed for the fractured vessel and the patient gradually recovered from the hypovolemic shock.
Microcoil localization is a relatively safe and effective way of preoperative localization of lung nodules, however, hemorrhagic shock could be induced by rupture of pleural aberrant vessels subsequent to puncture related pneumothorax. Shorten the time interval between localization and thoracoscopic surgery, extend the monitoring time after localization might help to reduce the risk of these complications.
电视辅助胸腔镜手术（VATS）是微创外科领域的一项新兴技术，已被公认为早期肺癌的标准治疗方法。微线圈定位被认为是术前定位的一种安全有效的方法，对于 VATS 楔形切除术治疗肺结节至关重要。
我们在此报告一例罕见病例，一名 28 岁女性患者在 CT 引导下微线圈定位后发生迟发性气胸，导致出血性休克。胸部 CT 显示微线圈定位后 10 小时右侧胸腔出现液气胸，患者血红蛋白水平显著下降（87g/L）。紧急胸腔镜探查显示，出血性休克是由迟发性气胸引起的，导致粘连胸膜索断裂和异常血管破裂。随后对破裂血管进行电凝止血，患者逐渐从低血容量性休克中恢复。
微线圈定位是肺结节术前定位的一种相对安全有效的方法，但是，与穿刺相关的气胸可导致胸膜异常血管破裂，从而引发出血性休克。缩短定位和胸腔镜手术之间的时间间隔，延长定位后的监测时间可能有助于降低这些并发症的风险。
