Smith Jason W, Franklin Glen A, Harbrecht Brian G, Richardson J David
Department of Surgery, University of Louisville, Louisville, KY, USA.
J Trauma. 2011 Jul;71(1):102-5; discussion 105-7. doi: 10.1097/TA.0b013e3182223080.
Retained hemothorax and/or empyema is a commonly recognized complication of penetrating chest injuries that may be treated by early video-assisted thoracoscopy (VATS). However, the use of VATS in blunt chest trauma is less well defined. Our acute care surgeon (ACS) group aggressively treats complications of penetrating chest trauma with VATS, and our results suggested that the early use of VATS by ACS should be expanded.
A retrospective review of Trauma Center admissions between January 2007 and December 2009 was performed to identify patients with blunt thoracic injuries who underwent VATS.
Eighty-three patients underwent VATS to manage thoracic complications arising from their blunt chest trauma. All operations were performed by ACS. The majority of patients (73%, 61 of 83) were treated with VATS for retained hemothorax, 18% for empyema (15 of 83), and 10% for persistent air leak (8 of 83). All (15) patients who developed empyema had chest tubes placed in the emergency department. No patient treated with VATS for a persistent air leak required further operation or conversion to thoracotomy. VATS performed ≤5 days after injury was associated with a lower conversion to open thoracotomy (8% vs. 29.4%, p < 0.05). Hospital length of stay (LOS) was significantly lower for patients receiving VATS ≤5 days after injury (11 ± 6 vs. 16 ± 8, p < 0.05). No patient treated with VATS ≤5 days had persistent empyema; however, five patients treated with VATS for retained hemothorax or empyema >5 days after injury required further intervention for thoracic infection. Multivariate analysis demonstrated that both a diagnosis of empyema and VATS >5 days after injury were predictors of increased LOS and increased conversion to thoracotomy.
Early VATS can decrease hospital LOS and thoracotomy rate in patient suffering blunt thoracic injuries. ACS can perform this procedure safely and effectively.
血胸残留和/或脓胸是穿透性胸部损伤常见的公认并发症，可通过早期电视辅助胸腔镜手术（VATS）进行治疗。然而，VATS在钝性胸部创伤中的应用尚不太明确。我们的急性创伤外科医生（ACS）团队积极采用VATS治疗穿透性胸部创伤的并发症，我们的结果表明，ACS早期使用VATS的范围应扩大。
对2007年1月至2009年12月期间创伤中心收治的患者进行回顾性研究，以确定接受VATS治疗的钝性胸部损伤患者。
83例患者接受VATS治疗钝性胸部创伤引起的胸部并发症。所有手术均由ACS医生完成。大多数患者（73%，83例中的61例）因血胸残留接受VATS治疗，18%（83例中的15例）因脓胸接受治疗，10%（83例中的8例）因持续性气胸接受治疗。所有发生脓胸的患者（15例）在急诊科均放置了胸管。因持续性气胸接受VATS治疗的患者均无需进一步手术或转为开胸手术。受伤后≤5天进行VATS与较低的开胸手术转换率相关（8%对29.4%，p<0.05）。受伤后≤5天接受VATS治疗的患者住院时间（LOS）显著缩短（11±6天对16±8天，p<0.05）。受伤后≤5天接受VATS治疗的患者均无持续性脓胸；然而，5例受伤后>5天因血胸残留或脓胸接受VATS治疗的患者因胸腔感染需要进一步干预。多因素分析表明，脓胸诊断和受伤后VATS治疗>5天均是LOS延长和开胸手术转换率增加的预测因素。
早期VATS可降低钝性胸部损伤患者的住院时间和开胸手术率。ACS医生能够安全有效地实施该手术。
