Abstract
Background: Spontaneous hemopneumothorax, a life-threatening and rare disorder and complication
of primary spontaneous pneumothorax, is regarded as a surgical emergency. We have
prospectively investigated the differences in safety and utility between minithoracotomy
with simultaneous video-assisted thoracoscopic surgery (MT + VATS) and the video-assisted
thoracoscopic surgery approach (VATS) in the treatment of spontaneous hemopneumothorax.
Methods: From Jan 1998 to May 2002, 248 patients with primary spontaneous pneumothorax were
treated in our hospital. Among these patients, 12 (4.8 %) spontaneous hemopneumothorax
occurred, all in the first episode of spontaneous pneumothorax. After tube thoracostomy,
the amount of blood drainage ranged from 500 to 1,500 ml. 8 patients were treated
by MT + VATS and 4 by VATS. Results: During surgery, the sources of hemorrhage were all from the torn aberrant vessels
between the apical blebs and the parietal pleura. The duration of main surgical procedure
(including removal of blood clot in pleural cavity, control of bleeding and blebectomy)
was significantly shorter in MT + VATS than in VATS (p < 0.01, Mann-Whitney U). There
were no differences between these two groups in postoperative chest tube drainage
duration, average postoperative pain score or hospital stay. No relapses occurred
in the succeeding 6 months to 4 years. Conclusions: Spontaneous hemopneumothorax is usually treated as an urgent surgical condition.
MT + VATS is an easy accessible and safe procedure that could be applied as an initial
treatment method in the patient with spontaneous hemopneumothorax, especially in the
treatment of the patients with active hemorrhage and massive blood clot in the thorax.
Key words
Minithoracotomy - spontaneous hemopneumothorax - spontaneous pneumothorax - video-assisted
thoracoscopic surgery (VATS)
References
Correspondence
hsiaomod@ndmctsgh.edu.tw
