Samiatina Diana, Rubikas Romaldas
Clinic of Thoracic Surgery, Kaunas University of Medicine Hospital, Eiveniu 2, 3007 Kaunas, Lithuania.
Medicina (Kaunas). 2004;40 Suppl 1:134-8.
To prove that video-assisted thoracoscopic surgery in selected cases is an alternative to urgent thoracotomy following open chest trauma.
Retrospective analysis of case reports of patients operated for open chest trauma during 1997-2002. Comparison of two methods of surgical treatment: urgent video-assisted thoracoscopy and urgent thoracotomy. Duration of drain presence in the pleural cavity, duration of postoperative treatment, pain intensity and cosmetic effect were evaluated. Data analysis was performed using SPSS statistical software. Statistical evaluation of differences between groups was performed using Mann-Whitney U test. The differences between groups were considered to be statistically significant when the probability of deviation was p<0.05.
During 1997-2002, 121 patients with open chest trauma were operated. Thirty three patients underwent urgent video-assisted thoracoscopy, 88 patients were operated through thoracotomy incision: 69 due to isolated open chest trauma, 17 due to thoracoabdominal injury and 2 due to abdominothoracic injury. Almost thirteen percent (12.5%) of patients after urgent thoracotomy underwent urgent laparotomy due to damaged diaphragm and other organs of peritoneal cavity. Duration of drain presence in the pleural cavity after video-assisted thoracoscopy was 4.57 days and after urgent thoracotomy - 6.88 days (p<0.05). Duration of post-operative treatment after video-assisted thoracoscopy was 8.21 days and after urgent thoracotomy - 14.89 days (p<0.05). Amount of consumed non-narcotic analgesics after video-assisted thoracoscopy was 1056.98 mg and after urgent thoracotomy - 1966.70 mg (p<0.05).
Video-assisted thoracoscopy is minimally invasive method of thoracic surgery allowing for the evaluation of the pathological changes in the lung, pericardium, diaphragm, mediastinum, thoracic wall and pleura, including the localization of these changes, and the type and severity of the injury. The number of early post-operative complications following video-assisted thoracoscopy is lower. Compared to operations through thoracotomy incision, video assisted thoracoscopies entail the shortening of the duration of drain presence in the pleural cavity and the duration of post-operative treatment. Video-assisted thoracoscopy should be performed on all patients with open chest trauma and stable hemodynamics and the respiration function. Video-assisted thoracoscopy is an informative diagnostic and treatment method allowing for the selection of patients for urgent thoracotomy.
证明在特定病例中，电视辅助胸腔镜手术可作为开放性胸部创伤后紧急开胸手术的替代方法。
回顾性分析1997年至2002年期间因开放性胸部创伤接受手术治疗的患者病例报告。比较两种手术治疗方法：紧急电视辅助胸腔镜检查和紧急开胸手术。评估胸腔引流管留置时间、术后治疗时间、疼痛强度和美容效果。使用SPSS统计软件进行数据分析。采用Mann-Whitney U检验对组间差异进行统计学评估。当偏差概率p<0.05时，组间差异被认为具有统计学意义。
1997年至2002年期间，121例开放性胸部创伤患者接受了手术。33例患者接受了紧急电视辅助胸腔镜检查，88例患者通过开胸切口进行手术：69例因单纯开放性胸部创伤，17例因胸腹联合伤，2例因腹胸联合伤。紧急开胸手术后，近13%（12.5%）的患者因膈肌及腹腔其他器官受损而接受了紧急剖腹手术。电视辅助胸腔镜检查后胸腔引流管留置时间为4.57天，紧急开胸手术后为6.88天（p<0.05）。电视辅助胸腔镜检查后术后治疗时间为8.21天，紧急开胸手术后为14.89天（p<0.05）。电视辅助胸腔镜检查后非麻醉性镇痛药消耗量为1056.98毫克，紧急开胸手术后为1966.70毫克（p<0.05）。
电视辅助胸腔镜检查是一种微创胸外科手术方法，可用于评估肺、心包、膈肌、纵隔、胸壁和胸膜的病理变化，包括这些变化的定位以及损伤的类型和严重程度。电视辅助胸腔镜检查术后早期并发症的数量较少。与开胸切口手术相比，电视辅助胸腔镜检查可缩短胸腔引流管留置时间和术后治疗时间。所有血流动力学稳定且呼吸功能正常的开放性胸部创伤患者均应进行电视辅助胸腔镜检查。电视辅助胸腔镜检查是一种信息丰富的诊断和治疗方法，可用于选择需要紧急开胸手术的患者。
