Freeman R K, Al-Dossari G, Hutcheson K A, Huber L, Jessen M E, Meyer D M, Wait M A, DiMaio J M
Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas 75390, USA.
Ann Thorac Surg. 2001 Aug;72(2):342-7. doi: 10.1016/s0003-4975(01)02803-x.
Video-assisted thoracoscopic surgery (VATS) has been shown to be an accurate method for identifying diaphragmatic injuries (DIs). The purpose of this investigation was to establish specific indications for the use of VATS after penetrating chest trauma.
A retrospective review of all patients undergoing VATS after penetrating chest trauma at a level 1 trauma center over an 8-year period was performed. Logistic regression was used in an attempt to identify independent predictors of DI.
One hundred seventy-one patients underwent VATS assessment of a hemidiaphragm, and 60 patients (35%) were found to have a DI. Five independent risk factors for DI were identified from analyzing the patient records: abnormal chest radiograph, associated intraabdominal injuries, high-velocity mechanism of injury, entrance wound inferior to the nipple line or scapula, and right-sided entrance wound.
In the largest published series of patients undergoing VATS to exclude a DI, this review identifies five independent predictors of DI after penetrating chest trauma. A diagnostic algorithm incorporating these five factors was designed with the goal of reducing the number of unrecognized DIs after penetrating chest trauma by using VATS for patients at greatest risk for such injuries.
电视辅助胸腔镜手术（VATS）已被证明是识别膈肌损伤（DI）的一种准确方法。本研究的目的是确定穿透性胸部创伤后使用VATS的具体指征。
对一家一级创伤中心8年间所有穿透性胸部创伤后接受VATS的患者进行回顾性研究。采用逻辑回归分析以确定DI的独立预测因素。
171例患者接受了半侧膈肌的VATS评估，其中60例（35%）被发现有DI。通过分析患者记录确定了DI的五个独立危险因素：胸部X线片异常、合并腹部损伤、高速致伤机制、乳头线或肩胛骨以下的入口伤口以及右侧入口伤口。
在已发表的接受VATS以排除DI的患者系列中规模最大的研究中，本综述确定了穿透性胸部创伤后DI的五个独立预测因素。设计了一种纳入这五个因素的诊断算法，目的是通过对最易发生此类损伤的患者使用VATS来减少穿透性胸部创伤后未被识别的DI数量。
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