Kong Victor Y, Clarke Damian L
Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa.
Injury. 2014 Sep;45(9):1435-9. doi: 10.1016/j.injury.2014.05.013. Epub 2014 May 21.
Iatrogenic visceral injuries (IVI) secondary to the insertion of an intercostal chest drain (ICD) are well documented, but are usually confined to case reports and small series.
We reviewed our experience with 53 consecutive patients over a insertion seven year period who sustained an IVI secondary to an ICD and describe the spectrum of injuries and clinical outcome in a high volume trauma service in South Africa.
A total of 53 ICDs were inserted in 53 patients, 83% (44/53) of which were on the left side, and 17% (9/53) on the right side. 92% (49/53) of the patients were males and the mean age for all patients was 24 (±8) years. 85% of the patients were referred from rural hospitals, the remaining 15% were treated initially at our institution. A trocar was used in 75% (40/53) of patients and in 9% (5/53), a trocar was not used, 58 organ injuries occurred in 53 patients. 92% (49/53) of patients sustained a single organ injury and 4 sustained multiple injuries. The three most common injuries were: diaphragm (36%, 21/53), gastric (22%, 13/53), and pulmonary (12%, 7/53). Other injuries were: 6 (10%) spleen, 4 (7%) liver, 2 (3%) colon and 1 (2%) kidney. Three (5%) sustained an injury to the intercostal artery and one (2%) sustained a pulmonary artery injury. 39 patients (74%) required operative interventions which included laparoscopy: 20 (51%), laparotomy: 8 (21%), thoracotomy: 8 (21%), VAT: 3 (8%). A total of 28 patients (53%) developed further complications: 13 wound sepsis, 7 pneumonia, 6 empyema, 2 ARDS. and 15% (8/53) required intensive care admission. The mean length of hospital stay was 7 (±4) days.
IVI is associated with significant morbidity, with diaphragmatic, gastric and pulmonary injuries being the most common. The majority were inserted in the rural hospitals and were associated with use of a trochar, Level of evidence: III, Study type: Retrospective study.
肋间胸腔引流管（ICD）置入继发的医源性内脏损伤（IVI）已有充分记录，但通常局限于病例报告和小样本系列研究。
我们回顾了连续7年期间53例因ICD置入继发IVI患者的情况，并描述了南非一家大型创伤中心的损伤谱及临床结果。
53例患者共置入53根ICD，其中83%（44/53）在左侧，17%（9/53）在右侧。92%（49/53）的患者为男性，所有患者的平均年龄为24（±8）岁。85%的患者由农村医院转诊而来，其余15%最初在我院接受治疗。75%（40/53）的患者使用了套管针，9%（5/53）未使用套管针，53例患者共发生58处器官损伤。92%（49/53）的患者为单器官损伤，4例为多器官损伤。最常见的三种损伤为：膈肌损伤（36%，21/53）、胃损伤（22%，13/53）和肺损伤（12%，7/53）。其他损伤包括：脾损伤6例（10%）、肝损伤4例（7%）、结肠损伤2例（3%）和肾损伤1例（2%）。3例（5%）发生肋间动脉损伤，1例（2%）发生肺动脉损伤。39例（74%）患者需要手术干预，包括腹腔镜手术：20例（51%）、剖腹手术：8例（21%）、开胸手术：8例（21%）、胸腔镜辅助手术：3例（8%）。共有28例（53%）患者出现进一步并发症：13例伤口感染、7例肺炎、6例脓胸、2例急性呼吸窘迫综合征。15%（8/5）的患者需要入住重症监护病房。平均住院时间为7（±4）天。
IVI与显著的发病率相关，膈肌、胃和肺损伤最为常见。大多数ICD在农村医院置入，且与套管针的使用有关。证据级别：III，研究类型：回顾性研究。
