Khat'kov I E, Izrailov R E, Pankratov A A, Zhdanov A V
Chair of Faculty Surgery #2 of A.I. Yevdokimov Moscow State Medical and Dental University.
Chair of Faculty Surgery #2 of A.I. Yevdokimov Moscow State Medical and Dental University; City Clinical Hospital #68, Moscow.
Khirurgiia (Mosk). 2016(1):15-19. doi: 10.17116/hirurgia2016115-19.
To analyze the results of laparo- and thoracoscopy in patients with thoracic and abdominal trauma in conditions of emergency hospital.
For the period 2006-2013 we performed 56 laparoscopic and 15 thoracoscopic interventions in 67 patients with trauma. There were 80.6% of men and 19.4% of women aged 35±1.7 years. Abdominal, thoracic and thoraco-abdominal injuries were observed in 51 (76.1%), 14 (20.9%) and 2 (3%) patients. Abdominal or thoracic trauma alone was diagnosed in 41 (61.2%) cases and combined injury - in 26 (38.8%) patients. 37 (66%) interventions were performed laparoscopically. Conversion to laparotomy was observed in 19 (34%) cases. Mean volume of hemoperitoneum was 458 ml (range 100-1100 ml). In 11 (73.3%) patients thoracoscopic surgery was performed and conversion of access was applied in 4 (26.7%) cases.
No injuries of internal organs were observed in 19.6% and 13.3% of patients using laparo- and thoracoscopy respectively. So inadvisable open surgery was prevented although formal indications for laparo- and thoracotomy were present. In 25% and 20% of abdominal and thoracic damages respectively we avoided relatively unjustified laparo- or thoracotomy because of injuries were cured endoscopically. No one missed injury was observed. Postoperative complications were diagnosed in 5.6% of cases. Mortality rate was 15.6% in case of severe combined trauma. Mean hospital stay was 23.2 days (range 3-105).
Endoscopic techniques are perspective in treatment of thoracic and abdominal trauma. It allows to avoid inadvisable laparo- and thoracotomy in some cases and to improve results of treatment.
分析在急诊医院条件下，腹腔镜和胸腔镜检查在胸腹部创伤患者中的应用结果。
在2006 - 2013年期间，我们对67例创伤患者进行了56例腹腔镜手术和15例胸腔镜手术。患者中男性占80.6%，女性占19.4%，年龄为35±1.7岁。51例（76.1%）患者有腹部损伤，14例（20.9%）有胸部损伤，2例（3%）有胸腹联合损伤。仅腹部或胸部创伤的诊断为41例（61.2%），复合伤为26例（38.8%）。37例（66%）手术通过腹腔镜进行。19例（34%）病例中转开腹手术。腹腔积血平均量为458毫升（范围100 - 1100毫升）。11例（73.3%）患者进行了胸腔镜手术，4例（26.7%）病例中转开胸手术。
分别有19.6%和13.3%的患者通过腹腔镜和胸腔镜检查未发现内脏损伤。因此，尽管存在开腹和开胸手术的正式指征，但仍避免了不必要的开放手术。分别有25%和20%的腹部和胸部损伤患者，由于损伤通过内镜治愈，从而避免了相对不合理的开腹或开胸手术。未观察到漏诊损伤。5.6%的病例诊断有术后并发症。严重复合伤患者的死亡率为15.6%。平均住院时间为23.2天（范围3 - 105天）。
内镜技术在胸腹部创伤治疗中具有前景。它能在某些情况下避免不必要的开腹和开胸手术，并改善治疗效果。
