Vivekanandan Deepak Dev, Louis Mena, Canaan Lucas N, Gersch Karen
General Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
Cureus. 2024 Nov 19;16(11):e73999. doi: 10.7759/cureus.73999. eCollection 2024 Nov.
Hemothorax is a serious complication following thoracic surgery, often resulting from vessel injury or rib fractures, and is typically managed with chest tube drainage. Persistent or loculated hemothorax, referred to as retained hemothorax, may require more invasive interventions, such as thoracotomy. Although the intrapleural administration of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) has shown promise in managing pleural infections, its use for hemothorax remains controversial due to bleeding risks. We present a case of a 74-year-old female who developed a retained hemothorax following a robotic left upper lobectomy for lung cancer. Initial chest tube drainage was insufficient, and her high-risk status rendered her unsuitable for further surgery. After a thorough evaluation and obtaining informed consent, intrapleural tPA and DNase were administered, resulting in significant clinical and radiographic improvement without complications. This case suggests that intrapleural tPA and DNase may be a potential alternative to surgery for managing retained hemothorax. Further studies are needed to establish treatment guidelines.
血胸是胸外科手术后的一种严重并发症，通常由血管损伤或肋骨骨折引起，一般通过胸腔闭式引流进行处理。持续性血胸或局限性血胸，即所谓的存留血胸，可能需要更具侵入性的干预措施，如开胸手术。尽管胸膜腔内注射组织型纤溶酶原激活剂（tPA）和脱氧核糖核酸酶（DNase）在治疗胸膜感染方面已显示出前景，但其用于血胸治疗因出血风险仍存在争议。我们报告一例74岁女性患者，她在接受机器人辅助左上肺叶切除肺癌手术后发生了存留血胸。最初的胸腔闭式引流效果不佳，且她的高危状态使她不适合进一步手术。经过全面评估并获得知情同意后，给予胸膜腔内注射tPA和DNase，结果临床和影像学均有显著改善且无并发症。该病例表明，胸膜腔内注射tPA和DNase可能是治疗存留血胸的一种潜在替代手术的方法。需要进一步研究以制定治疗指南。
