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Clinical Experience of Spontaneous Hemopneumothorax

자연성 혈기흉의 임상적 경험

  • Moon, Hyeon-Jong (Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center) ;
  • Hwang, Seong-Wook (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital)
  • 문현종 (시립보라매병원 흉부외과) ;
  • 황성욱 (분당서울대학교병원 흉부외과)
  • Received : 2010.09.27
  • Accepted : 2010.11.12
  • Published : 2010.12.05

Abstract

Background: Spontaneous hemopneumothorax is characterized by the accumulation of air and more than 400 mL of blood in pleural cavity without any apparent cause. It is a rare disease and can cause life-threatening situation. We analyzed clinical reviews of two medical centers to aid in optimal management. Material and Method: Retrospective review between March 2003 and August 2010 with 18 spontaneous hemopneumothorax patients was made. Result: These 18 patients were comprised of 15 male and 3 female with average 24.6 years (range 15~46 years). Almost patients (16) underwent a closed thoracostomy initially and 15 patients received video-assisted thoracic surgery (VATS). Mean postoperative chest tube removal was 2.9 days and one complication was post-removal pneumothorax. During the follow-up periods there were no other complications and recurrence. Conclusion: Proper initial diagnosis and management of spontaneous hemopneumothorax prevent significant hypovolemic shock. Video-assisted thoracic surgery should be considered an early surgical management in spontaneous hemopneumothorax. However conservative manage without bleb excision may be effective in selected patients.

배경: 자연성 혈기흉은 외상이나 다른 뚜렷한 원인 없이 흉강 내 공기와 400 mL 이상의 혈액이 동시에 쌓이는 질환이다. 드문 질환이지만 생명을 위협할 수도 있는 질환이기도 하다. 이 질환의 적절한 치료를 알아보고자 두 병원에서 치료받은 환자들을 분석하였다. 대상 및 방법: 2003년 3월부터 2010년 8월까지 치료받은 18명의 자연성 혈기흉 환자들을 후향적으로 조사하였다. 결과: 18명의 환자들 중 남자 15명 여자 3명이었고 평균 나이는 24.6세이었다. 16명의 환자는 우선적으로 폐쇄식 흉관 삽입술을 시행하였으며 15명의 환자는 흉강경을 통한 수술적 치료를 하였다. 수술 후 흉관 제거는 평균 2.9일에 이루어졌으며, 수술 후 합병증으로 흉관 제거 후 기흉이 한 명 있었다. 퇴원 후 다른 합병증이나 재발은 추적기간 동안 없었다. 결론: 초기의 적절한 진단과 치료가 치명적인 쇼크 상태를 방지하며, 흉강경을 통한 조기 수술이 자연성 혈기흉의 치료가 될 것이다. 그러나 보전적 치료도 일부 환자에게는 효과적이다.

Keywords

References

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