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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

lingua: Inglese

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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