外傷性巨大肋膜外血種：案例報告

Huge Traumatic Extrapleural Hematoma: A Case Report

簡定國 ； 盧立華 ； 蔡行瀚 ； 蔡維謀 ； 王國新 ； 吳雪如 ； 劉洪彰

《中華民國急救加護醫學會雜誌》 14卷4期 (2003/12) Pp. 164-168

https://doi.org/10.30018/JECCM.200312.0005

摘要

外傷性肋膜外血腫(traumatic extrapleural hematoma)雖很常見，但大多數臨床醫師卻非常陌生。對於巨大外傷性肋膜外血腫瞭解不夠，可能會導致病人之死亡。本文報告一位72歲男性慢性阻塞性肺疾病患者，跌倒造成肋骨骨折，合并巨大外傷性肋膜外轎腫，經開胸手術，成功救治之案例，討論其發生之機轉、診斷及治療方式的選擇。本文強調胸部X光檢查、電腦斷層掃描檢查及血管攝影檢查對於診斷巨大之傷性肋膜外血腫之必要性；反對於受傷初其，以針頭穿刺信胸管插管引流；建議一旦出現呼吸或循環障礙時，應盡速開胸手術治療。

關鍵字

巨大肋膜外血腫 ； 肋間動脈破裂 ； 外科治療

並列摘要

The clinical figures for traumatic extra-pleural hematoma, the most common injury encountered at an emergency department, have not yet been fully understood by emergency physicians. A lack of an appropriate understanding may lead to patient mortality as a consequence. In this case study, a 72-year-old patient presented with chronic obstructive pulmonary disease and had developed a huge traumatic extra-pleural hematoma as a result of multiple rib fractures after an incident where he had fallen down. After prompt surgical intervention in the form of a thoracotomy, a successful outcome for the patient was obtained. The focus of this study emphasizes the value of chest radiology, computer tomography (CT) and angiography. Interventions such as needle aspiration of or chest tube drainage of the hematoma are not suggested. Surgical interventions should be implemented immediately when there are any signs of respiratory or hemodynamic compromise. This approach has been supported over the past decades in a series of successful reports on surgical intervention after the occurrence of traumatic extra-pleural hematoma.

並列關鍵字

huge extra-pleural hematoma ； intercostal arteries rupture ； surgical intervention