Hsu N Y, Hsieh M J, Liu H P, Kao C L, Chang J P, Lin P J, Chang C H
Division of Cardiovascular and Thoracic Surgery, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, Republic of China.
World J Surg. 1998 Jan;22(1):23-6; discussion 26-7. doi: 10.1007/s002689900344.
We operated on 403 patients with spontaneous pneumothorax between 1992 and 1996. Among these cases, 11 (2.7%) were spontaneous hemopneumothorax. The patients were all men, with ages ranging from 19 to 28 years (mean 23.8 years). The amount of blood drainage ranged from 650 to 2300 ml. Video-assisted thoracoscopic surgery was performed on these patients within 1 day after admission. The sources of bleeding were in the parietal and visceral pleurae of ruptured bullae (n = 6), the parietal pleura (n = 4), or the visceral pleura (n = 1). During operation, the ruptured bullae can be managed by an endoscopic linear stapler for a bullectomy, and the bleeding parietal pleura of the torn adhesion can be coagulated directly. Postoperative recovery of the 11 patients was uneventful, and they were discharged 4 to 10 days after the operation. No recurrence of spontaneous hemopneumothorax or any other complications occurred during follow-up. Thus spontaneous hemopneumothorax can be readily managed by cauterizing a bleeding site where appropriate, excising the apicocystic disease, and pleurodesis. As a minimally invasive method, video-assisted thoracoscopic surgery may be considered an initial treatment procedure in patients with spontaneous hemopneumothorax.
1992年至1996年间，我们对403例自发性气胸患者进行了手术。在这些病例中，11例（2.7%）为自发性血气胸。患者均为男性，年龄在19岁至28岁之间（平均23.8岁）。出血量在650至2300毫升之间。这些患者在入院后1天内接受了电视辅助胸腔镜手术。出血来源为破裂肺大疱的壁层和脏层胸膜（n = 6）、壁层胸膜（n = 4）或脏层胸膜（n = 1）。手术过程中，破裂的肺大疱可用内镜直线切割缝合器进行肺大疱切除术，撕裂粘连处出血的壁层胸膜可直接进行凝固止血。11例患者术后恢复顺利，术后4至10天出院。随访期间未发生自发性血气胸复发或任何其他并发症。因此，自发性血气胸可通过适当烧灼出血部位、切除尖部囊性病变和胸膜固定术轻松处理。作为一种微创方法，电视辅助胸腔镜手术可被视为自发性血气胸患者的初始治疗手段。
