42例外伤性凝固性血胸诊治分析

目的探讨外伤性凝固性血胸(TCHT)的诊断、发生原因及治疗方法。方法对1999年12月～2006年10月该科收治的42例TCHT的临床资料进行回顾性总结。采用胸膜腔内注入尿激酶法治疗25例,行血凝块清除、纤维板剥脱术治疗27例。结果保守治疗治愈15例占60%。经治疗后所有病例伤侧肺复张均在95%以上。结论治疗方法不当、复查不及时、胸腔引流不通畅、对迟发性血胸的认识不足、被迫体位、呼吸动度受限是造成TCHT的常见原因。对于有手术指征而无手术禁忌证的病人,应尽早手术,宜选择胸部前外侧切口,手术以肺能复张为准。

Diagnosis and treatment of 42 cases of traumatic clotted hemothorax

Objective] To investigate diagnosis, causes and treatment of traumatic clotted hemothorax(TCHT). Methods] The clinical data of 42 cases of TCHT from December 1999 to October 2006 was retrospectively analysed in our department. Intrapleural urokinase injection on TCHT was adopted in 25 cases. Clearance of blood clot and decortication of lung was adopted in 27 cases. Resoults] 15 cases(60%) were cured with conservative treatment. The recruited lung volume of traumatic side was over 95% after treatment in all cases. Conclusion] The common causes of TCHT were in terms of unsuitable therapy method, lingering reexamined, blockage of the thoracic drainage, lack of understand at delayed hemathorax , strained posture, restriction of respiratory mobility. It was suggested that patients with surgical indications and without contraindications should be operated as early as possible, and should be excised via anteriolateral thoracotomy. Surgical management should be according to the aim of properly recruited lung volume.