[胸腔镜在胸部创伤手术中的应用]

[Thoracoscopy in surgery of thoracic wounds].

作者信息

Zhestkov K G, Guliaev A A, Abakumov M M, Voskresenskiĭ O V, Barskiĭ B V

出版信息

Khirurgiia (Mosk). 2003(12):19-23.

Abstract

One hundred and sixty-eight thoracoscopic operations were performed in patients with closed (47.5%) and open (52.5%) trauma of the chest. Thoracoabdominal injuries were diagnosed in 23.9% patients. Thoracoscopic surgeries were performed in 79.8% patients, surgeries from the mini-approach - in 17.3%. Injuries uncorrectable by endosurgically were diagnosed during thoracoscopy in 2.9% patients. Indications for urgent thoracoscopy in thoracic injuries are the following: 1) middle and small hemothorax or hemopneumothorax; 2) suspicion for heart wound; 3) suspicion for diaphragm injury; 4) tense pneumothorax. Surgical policy and technique of endosurgeries in open thoracic trauma are optimized. Up-to-date surgical policy based on thoracoscopy permitted us to improve results of surgical treatment: to reduce lethality by 4.7%, number of complications - 2.9 times and completely avoid unjustified 'diagnostic' thoracotomies. Mini-invasive surgical methods promoted early rehabilitation of patients with trauma of the chest.

摘要

对168例闭合性（47.5%）和开放性（52.5%）胸部创伤患者进行了胸腔镜手术。23.9%的患者诊断为胸腹联合伤。79.8%的患者接受了胸腔镜手术，17.3%的患者接受了微创入路手术。在胸腔镜检查期间，2.9%的患者诊断出无法通过内镜手术矫正的损伤。胸部损伤紧急胸腔镜检查的指征如下：1）中、少量血胸或血气胸；2）怀疑心脏损伤；3）怀疑膈肌损伤；4）张力性气胸。开放性胸部创伤的内镜手术策略和技术得到了优化。基于胸腔镜检查的最新手术策略使我们能够改善手术治疗效果：将死亡率降低4.7%，并发症数量减少2.9倍，并完全避免不必要的“诊断性”开胸手术。微创外科方法促进了胸部创伤患者的早期康复。