自发性血气胸29例诊治分析

Outcomes of spontaneous hemopneumothorax:29 cases analysis

目的总结自发性血气胸(SHP)的诊治经验。方法回顾性分析29例SHP患者的临床资料。A组,17例,为2006年前收治,其中的3例保守治疗,14例初诊即行电视胸腔镜手术(VATS)治疗(A1组),手术指征为失血性休克、持续性出血、持续性肺漏气和复发性气胸。B组,12例,为2006-2010年收治,确诊后均尽早VATS治疗。结果 B组输血治疗例数、输血量和住院时间显著少于A组(P<0.05)。B组手术等待时间、术前引流量、总失血量和术中探及胸腔血块例数均显著低于A1组。所有手术患者均恢复良好,无同侧复发。A组3例行保守治疗患者,随访过程中1例出现肺膨胀不全而行开胸胸膜剥脱术。结论保守治疗SHP效果不佳;早期VATS治疗SHP安全、有效。

Objective To summarize the experience in the management of spontaneous hemopneumothorax（SHP）. Methods Data of 29 SHP patients were retrospectively reviewed. Seveteen cases were admitted before 2006 （group A）, of whom 3 cases were treated conservatively and 14 cases（group A1） underwent video-assisted thoracoscopic surgery（VATS） because of hypovolemic shock, continuous bleeding, persistent air leakage or recurrent pneumotborax. Twelve patients （group B） were admitted after 2006 and VATS was performed once the diagnosis of SHP was made. The outcomes were compared. Results Compared to group A, the number of patients received blood transfusion,the amount of blood transfusion and hospital stay were significantly lower in group B （P〈0. 05）. The preoperative stay, preoperative bleeding amount, total bleeding amount and the number of patients with retained clots were significantly higher in group A1 than those in group B. No recurrence of SHP occurred during follow-up in the patients treated with VATS. One out of three patients, who were treated conservatively in group A, required decortication later during follow-up. Condttsion The conservative therapy is not a good choice for the patients with SHP. Early VATS is effective and safe in SHP patients.