Department of Surgery, Creighton University School of Medicine, Omaha, NE, United States; Department of Clinical Science and Translational Research, Creighton University School of Medicine, Omaha, NE, United States.
Department of Surgery, University of Kansas Medical Center, Kansas City, KS, United States.
Int J Surg. 2017 Oct;46:71-74. doi: 10.1016/j.ijsu.2017.08.570. Epub 2017 Aug 31.
Thoracic injuries are common in both blunt and penetrating trauma. Most thoracic injuries are managed non-operatively, approximately 7-20% undergo thoracotomy. Of the injuries requiring thoracotomy, 1-6% ultimately require pulmonary resection. Wedge resection and lobectomies are well-studied in the literature; however, there is a paucity regarding reports on total pneumonectomy in the setting of trauma. Our objectives were to summarize the evidence supporting the role of trauma pneumonectomy (TP) in the current era and reiterate that despite the associated morbidity and mortality TP is justified in selective cases.
A review of the world's literature was conducted following standard guidelines. Inclusion criteria included those studies reviewing blunt and penetrating trauma to the lungs in adults (age greater than 15 year) that reported mortality rates and outcome measures.
The PubMed search yielded 713 studies. Of these, 14 studies included pertinent information on TP. Studies included in this review were published from 1985 to 2017 and involved patient data that was collected from 1972 to 2014. Mortality ranged from 50% to 100% (median 63%; mean 68%).
In the setting of severe thoracic trauma, pulmonary resection may be necessary. Less aggressive techniques are options in a stable patient; however, in the setting of ongoing hemorrhage, TP should be considered and expediently conducted. The role of damage control thoracic surgery and related techniques is vitally important in these patients to improve the significant mortality of trauma pneumonectomy.
胸部损伤在钝性和穿透性创伤中都很常见。大多数胸部损伤采用非手术治疗，约 7-20%需要开胸手术。在需要开胸手术的损伤中，1-6%最终需要进行肺切除术。楔形切除术和肺叶切除术在文献中有充分的研究；然而，关于创伤性全肺切除术的报告却很少。我们的目的是总结支持在当前时代进行创伤性全肺切除术（TP）的证据，并再次强调尽管存在相关的发病率和死亡率，但在选择性病例中，TP 是合理的。
按照标准指南对世界范围内的文献进行了回顾。纳入标准包括那些回顾成人（年龄大于 15 岁）肺部钝性和穿透性创伤并报告死亡率和结局指标的研究。
PubMed 搜索产生了 713 项研究。其中，有 14 项研究包括有关 TP 的相关信息。本综述中纳入的研究发表于 1985 年至 2017 年，涉及从 1972 年至 2014 年收集的患者数据。死亡率范围从 50%到 100%（中位数 63%；平均值 68%）。
在严重胸部创伤的情况下，可能需要进行肺切除术。在稳定的患者中，采用不太激进的技术是一种选择；然而，在持续出血的情况下，应考虑进行 TP，并迅速进行。损伤控制性胸外科手术和相关技术在这些患者中具有至关重要的作用，可以降低创伤性全肺切除术的高死亡率。
