背景:皮下气肿(SE)是胸管造口术或其他心胸手术的常见且通常是自限性的并发症。在极少数情况下,以可触及的皮肤张力为特征的严重和广泛的外科肺气肿,吞咽困难,发音困难,眼睑闭合或与气腹相关,气道损害,“紧张现象”和呼吸衰竭需要治疗。
方法:一位67岁的女性在终末期慢性阻塞性肺疾病(COPD)和新诊断的肺癌的背景下出现了大量自发性气胸,在插入胸腔引流器后发展为广泛的外科肺气肿。插入大孔后观察到立即改善,26法语(法语。)肋间导管,皮下引流器在低吸力(-5cmH2O)下再维持24小时。
结论:文献中已经描述了几种治疗广泛皮下气肿的方法,包括:急诊气管切开术,多部位皮下引流,锁骨下“吹孔”切口和皮下引流或只是在原位胸腔引流上增加吸力。这里有一个大口径,开窗的,维持低负压的皮下引流也提供了必要的减压。
结论:在缺乏比较研究以确定最有效的方法来治疗广泛的皮下气肿的情况下,这个案例凸显了一种有效的,简单和安全的管理选项。
BACKGROUND: Subcutaneous emphysema (SE) is a frequent and often self-limiting complication of tube thoracostomy or other cardiothoracic procedures. On rare occasions, severe and extensive surgical emphysema marked by palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, \"tension phenomenon\" and respiratory failure require treatment.
METHODS: A 67 year old lady presented with a large spontaneous pneumothorax on the background of end-stage chronic obstructive pulmonary disease (COPD) and newly diagnosed lung cancer, developed extensive surgical emphysema following insertion of a chest
drain. Immediate improvement was observed after insertion of a large-bore, 26 French (Fr.) intercostal catheter, subcutaneous
drain which was maintained under low suction (-5 cm H2O) for a further 24 h.
CONCLUSIONS: Several methods have been described in the literature for the treatment of extensive subcutaneous emphysema, including: emergency tracheostomy, multisite subcutaneous drainage, infraclavicular \"blow holes\" incisions and subcutaneous drains or simply increasing suction on an in situ chest
drain. Here a large-bore, fenestrated, subcutaneous
drain maintained on low negative pressure also provided the necessary decompression.
CONCLUSIONS: In the absence of a comparative study to identify the most effective method to manage extensive subcutaneous emphysema, this
case highlights an effective, simple and safe management option.