Farooqui Asif Masroor, Cunningham Clare, Morse Nick, Nzewi Onyekwelu
Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.
Emergency Department, Royal Victoria Hospital, Belfast, UK.
BMJ Case Rep. 2019 Mar 4;12(3):e227879. doi: 10.1136/bcr-2018-227879.
Clamshell thoracotomy for thoracic injuries is an uncommon emergency department procedure. The survival rates following emergency thoracotomy are very low at 9%-12% for penetrating trauma and 1%-2% for blunt trauma. We report an unusual case of survival after emergency department clamshell thoracotomy for penetrating thoracic trauma with cardiac tamponade in a 23-year-old man with multiple stab wounds on the chest and abdomen. The patient was awake and alert on arrival in the emergency department. Bilateral chest decompression by needle thoracostomy released air and blood. During subsequent chest drain insertion, the patient suddenly deteriorated and arrested. Clamshell thoracotomy was performed, and sinus rhythm restored before transfer to theatre. Following repair of the thoracic injuries, a midline laparotomy was performed as bleeding was suspected from the abdomen and a splenic injury repaired. The patient survived and has made a full recovery. This case demonstrates how clamshell thoracotomy can be a life-saving procedure.
用于胸部损伤的蛤壳式开胸术是急诊科一种不常见的手术。急诊开胸术后的生存率很低，穿透性创伤为9%-12%，钝性创伤为1%-2%。我们报告了一例不同寻常的病例，一名23岁男性胸部和腹部多处刺伤，因穿透性胸部创伤伴心脏压塞在急诊科接受蛤壳式开胸术后存活。患者到达急诊科时清醒且警觉。经针胸造口术进行双侧胸部减压，排出气体和血液。在随后插入胸腔引流管时，患者突然病情恶化并心跳骤停。进行了蛤壳式开胸术，在转送至手术室之前恢复了窦性心律。修复胸部损伤后，由于怀疑腹部出血并对脾损伤进行了修复，进行了正中剖腹术。患者存活并已完全康复。该病例证明了蛤壳式开胸术如何能够成为一种挽救生命的手术。
