Acute Management of Massive Spontaneous Hemopneumothorax: Beyond Thoracotomy with Thoracoscopy

緊急處置大量自發性血氣胸：超越傳統開胸法的胸腔鏡手術

史兆明(Chao-Ming Shih)

《中華民國急救加護醫學會雜誌》 21卷2期 (2010/06) Pp. 105-110

https://doi.org/10.30018/JECCM.201006.0007

摘要

自發性血氣胸有時會造成大量失血甚至休克，因此有潛在致命的危險性。我們報告一位42歲的男性病患因為胸痛和呼吸困難被送到急診室，胸部X光片疑似出現左側自發性氣胸併血胸，經緊急置入胸管引流證實。住院後三個小時內胸管持續引流出大量鮮血，即使接受積極的輸液及輸血治療，病患仍然出現低血容性休克，因此我們緊急安排手術探查出血位置。術中我們在胸腔鏡輔助下以迷你開胸手術有效地移出胸腔內大量血塊，迅速地找到出血位置並進行止血以穩定病患的生命徵象，同時也將破裂的肺泡切除以封住漏氣的肺部。病患術後的恢復相當順利，在十個月的門診追蹤內未發現氣胸復發。同時回顧目前文獻上對於自發性血氣胸的治療方式加以討論。

關鍵字

自發性血氣胸 ； 迷你開胸手術 ； 胸腔鏡輔助开胸手術

並列摘要

Spontaneous hemopneumothorax is commonly seen clinically, but in concomitant with massive hemothorax causing hemorrhagic shock which is fiat often seen. A 42 year-old man, without traumatic or lung disease history, presented to emergency department with sudden onset of chest pain and dyspnea. Chest radiographs supported the diagnosis of left spontaneous hemopneumothorax, and hemothorax was confirmed after tube thoracostomy was performed immediate/v. However, sustained bleeding and hypovolemic shock developed 3 hours later in spite of aggressive fluid and blood resuscitation. Emergent surgical exploration with video-assisted minithoracotomy was performed. Which treated the patient successfully without complications or recurrence during ten months follow-up. We report this case with literature review to emphasize the importance of treatment of spontaneous hemopneumothorax.

並列關鍵字

spontaneous hemopneumothorax ； minithoracotomy ； video-assisted thoracoscopic surgery