Video-assisted Thoracoscopic Surgery in Posttraumatic Localized Clotted Hemothorax

외상 후 국소적으로 응고된 혈흉의 비디오흉강경수술

  • 이정희 (화순고려병원 흉부외과) ;
  • 김정중 (조선대학교 의과대학 흉부외과학교실) ;
  • 이석기 (조선대학교 의과대학 흉부외과학교실) ;
  • 임진수 (조선대학교 의과대학 흉부외과학교실) ;
  • 최형호 (조선대학교 의과대학 흉부외과학교실)
  • Published : 2004.12.01

Abstract

Background: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. Material and Method: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. Result: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8$\pm$3.8 months) in group I were none, but in group II (21.5$\pm$5.3 months) were 2 cases. Conclusion: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

배경: 외상성 혈흉에서 부적절한 배액은 농흉, 섬유흉 및 늑막석회화 등 합병증으로 입원 기간을 연장시킨다. 외상성 혈흉 80%에서는 단순 흉강삽관술로 치료가 되지만, 나머지 경우는 수술적 치료가 필요하다. 대상 및 방법: 2002년 3월부터 2003년 2월까지 흉강삽관술을 시행했던 123예 중 조기에 비디오 흉강경으로 저류된 응고된 혈흉을 제거하였던 10명(group I)과 국소적 혈흉 혹은 농흉으로 수술을 받았던 5명(group II)을 대상으로 하였다. 두 군에서 남자가 여자보다 많았으며, 평균 나이는 비슷하였다. 수상 원인은 교통사고가 가장 많았으며, 가장 흔히 동반된 병변은 복부였다. 결과: Group I에서 평균 수상일로부터 수술일까지 평균 기간, 수술 시간, 평균 흉관 유지 기간 및 재원기간은 group II보다 더 짧았다(p<0.05). Group I에서는 추적 관찰 기간(17.8$\pm$3.8개월) 중 재발되거나 수술과 관련된 합병증은 없었으나, group II(21.5$\pm$5.3 months)에서는 2예가 있었다. 결론: 외상성 혈흉에 남아 있는 국소적으로 응고된 혈흉을 비디오 흉강경으로 7일 이내에 제거한다면 안전하고 효과적이다.

Keywords

References

  1. Mancini M, Smith LM, Nein A, Buechter KJ. Early evacuation of clotted blood in hemothorax using thoracoscopy: case reports. J Trauma 1993;34:144-7. https://doi.org/10.1097/00005373-199301000-00028
  2. Heniford BT, Carrillo EH, Spain DA, Sosa JL, Fulton RL, Richardson JD. The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg 1997;63:940-3. https://doi.org/10.1016/S0003-4975(97)00173-2
  3. Abolhoda A, Livingston DH, Donahoo JS, Allen K. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg 1997;12:356-60. https://doi.org/10.1016/S1010-7940(97)00192-9
  4. Condon RE. Spontaneous resolution of experimental clotted hemothorax. Surg Gynecol Obstet 1968;126:505-51.
  5. Wilson JM, Boren CH, Peteson SR, Thomas AN. Traumatic hemothorax: is decortication necessary? J Thorac Cardio Vasc Surg 1979;77:489-95.
  6. Burford TH, Parker EF, Sampson PC. Early pulmonary decortication in the treatment of post-traumatic empyema. Ann Surg 1945;122:163-90 https://doi.org/10.1097/00000658-194508000-00003
  7. Beall AC Jr, Bricker D, Crawford HW, Noon GP, DeBakey ME. Considerations in the management of penetrating thoracic trauma. J Trauma 1968;8:408-17. 6.
  8. Cordice JW Jr, Cabezon J. Chest trauma with pneumothorax and hemothorax: review of experience with 502 cases. J Thorac Cardiovasc Surg 1965;50:316-38.
  9. Milfeld DJ. Mattx KL, Beall AC Jr. Early evacuation of clotted hemothorax. Am J Surg 1978;136:686-92. https://doi.org/10.1016/0002-9610(78)90336-7
  10. Beall AC Jr, Crawford HW, DeBakey ME. Considerations in the management of acute traumatic hemothorax. J Thorac Cardiovascu Surg 1966;52:351-8.
  11. Bracho JMC. Thoracoscopy as a method of exploration in penetrating injuries of the chest. Dis Chest 1946;12:330-5 https://doi.org/10.1378/chest.12.4.330
  12. Smith RS, Fry WR, Tsoi EK, et al. Preliminary report on videothoracoscopy in the evaluation and treatment of thoracic injury. Am J Surg 1993;166:690-3. https://doi.org/10.1016/S0002-9610(05)80681-6
  13. Landreneau RJ, Keenan RJ, Hazelrigg SR, Mack MJ, Naunheim KS. Thoracoscopy for empyema and hemothorax. Chest 1996;109:18-24. https://doi.org/10.1378/chest.109.1.18
  14. Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg 1989;157:494-7. https://doi.org/10.1016/0002-9610(89)90643-0
  15. Abolhoda A, Livingston DH, Donahoo JS, Allen K. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg 1997;12: 356-60. https://doi.org/10.1016/S1010-7940(97)00192-9
  16. Tomaselli F, Maier A, Renner H, Smolle-Juttner FM. Thoracoscopical water jet lavage in coagulated hemothorax. Eur J Cardiothorac Surg 2003;23:424-5. https://doi.org/10.1016/s1010-7940(02)00803-5