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The Journal of Cardiovascular Surgery 2002 February;43(1):109-12

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Videothoracoscopy for evaluation and treatment of hemothorax

Ambrogi M. C., Lucchi M., Dini P., Mussi A., Angeletti C. A.

From the Division of Thoracic Surgery Cardiac and Thoracic Department University of Pisa, Pisa, Italy


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Back­ground. Hemo­thorax may be imme­di­ately ­life-threat­ening ­or lead to com­pli­ca­tions ­like ­empyema and fibro­thorax. The ­first ­step of man­age­ment is the place­ment of a ­tube thor­a­cos­tomy ­which is effi­ca­cious in ­more ­than 80% of ­cases. Con­tin­uous ­bleeding and ­retained ­blood, ­instead, ­require sur­gical treat­ment.
­Methods. ­From 1993 to 2000, 33 ­patients under­went vid­eo­tho­rac­os­copic treat­ment of hemo­thorax. It was ­post-sur­gical in 19 ­cases, spon­ta­neous in 8 and ­post-trau­matic in 6. Fif­teen ­patients had a con­tin­uous ­bleeding (>1500 mL/24 hrs) and 18 ­patients a ­retained hemo­thorax (≥500 mL). To ­better ­assess ­smaller ­retained col­lec­tion 11 ­patients under­went ­both CT ­scans and ­trans-tho­racic ultra­so­nog­raphy. ­Twenty-six ­patients (­group 1) ­were oper­ated ­within 7 ­days of the diag­nosis and 7 ­after 10 ­days (­group 2). Stan­dard vid­eo­tho­rac­os­copic equip­ment was util­ised ­with the ­patient ­under gen­eral ­anaesthesia and ­double ­lumen selec­tive intu­ba­tion. Two or ­three inci­sions ­were per­formed in axil­lary tri­angle (in the ­postsur­gical ­ones we ­always util­ised the ­existing inci­sions). Hemo­stasis was ­always ­achieved by ­clip liga­tion and elec­tro­cautery. ­Clotted ­blood under­went frag­men­ta­tion and suc­tion ­with a com­plete evac­u­a­tion fol­lowed by ­pleural ­washing ­with anti­bi­o­tics solu­tion.
­Results. Vid­eo­tho­ra­cos­copy was effec­tive in 32 ­cases. One ­patient of ­group 2 ­required con­ver­sion to ­open thor­a­cotomy due to the pres­ence of ­sticky ­pleural adhe­sions. Oper­ating ­time, ­mean ­drainage ­period and ­mean hos­pital ­stay ­were sen­si­tively ­shorter in ­patients of ­group 1 ­with ­respect to ­patients of ­group 2. At a ­mean ­follow-up of 39 ­months no ­relapses or com­pli­ca­tions ­were ­observed.
Con­clu­sions. Vid­eo­tho­ra­cos­copy ­seems to be ­safe and effec­tive in the treat­ment of hemo­thorax. To ­avoid pro­longed oper­a­tions, con­ver­sions to thor­a­cotomy and com­pli­ca­tions, it ­should be per­formed as ­soon as pos­sible. Actu­ally ­only mas­sive hem­or­rhages jus­tify the tho­rac­o­tomic ­approach.

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