Kawaguchi Marina, Yamamoto Hirotsugu, Yamada Taihei, Yumoto Tetsuya, Aokage Toshiyuki, Ihoriya Hiromi, Eto Koki, Suezawa Takanori, Naito Hiromichi, Nakao Atsunori
Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Int J Surg Case Rep. 2018;52:63-66. doi: 10.1016/j.ijscr.2018.09.052. Epub 2018 Oct 8.
Penetrating thoracic traumas have a wide spectrum, ranging from mild traumas to life-threatening injuries.
This paper illustrates a 40-year-old male with a penetrating pulmonary artery injury that was successfully treated with emergency surgery. The patient visited local hospital by foot complaining of moving object on his chest and was found that an ice pick was penetrating the man's left chest. An ambulance took the patient to our emergency department. Computed tomography of the chest showed linear metallic density in the pulmonary trunk and a small amount of pericardial fluid. Emergency surgery for removal of the object and repair of the pulmonary artery was performed. The ice pick had been stuck in the main pulmonary artery through the pericardium without any injury to the left lung or internal thoracic artery. Postoperative course was uneventful.
A multidisciplinary team designed our treatment strategy, enabling us to select the optimal treatment, including diagnostic techniques and surgical approach. A successful trauma management depends on whether a life-threatening conditionexists. Major vascular injury should be rapidly assessed in these cases. Psychiatric aspects of the case are also discussed.
Early removal of the foreign body is recommended to prevent further damage to the heart.
穿透性胸部创伤范围广泛,从轻伤至危及生命的损伤不等。
本文阐述了一名40岁男性,其肺动脉穿透伤经急诊手术成功治疗。患者步行前往当地医院,主诉胸部有异物移动,检查发现一把冰锥刺入其左胸。救护车将患者送至我院急诊科。胸部计算机断层扫描显示肺动脉主干有线性金属密度影及少量心包积液。遂行急诊手术取出异物并修复肺动脉。冰锥经心包刺入主肺动脉,未损伤左肺或胸廓内动脉。术后病程平稳。
一个多学科团队制定了我们的治疗策略,使我们能够选择最佳治疗方案,包括诊断技术和手术方式。成功的创伤管理取决于是否存在危及生命的情况。在这些病例中应迅速评估主要血管损伤情况。本文还讨论了该病例的精神方面问题。
建议尽早取出异物以防止对心脏造成进一步损伤。