胸壁损伤手术技术的回顾性比较

Retrospective comparison of operative technique for chest wall injuries.

作者信息

Öberg Westin Erik, Fagevik Olsén Monika, Örtenwall Per, Caragounis Eva-Corina

机构信息

Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 15, Gothenburg SE 413 45, Sweden.

Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 15, Gothenburg SE 413 45, Sweden; Department of Physical Therapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

出版信息

Injury. 2023 Mar 10. doi: 10.1016/j.injury.2023.03.012.

DOI:10.1016/j.injury.2023.03.012

PMID:36925375

Abstract

BACKGROUND

Surgical management of chest wall injuries is a common procedure. However, operative techniques are diverse, and no universal guidelines exist. There is a lack of studies comparing the outcome with different operative techniques for chest wall surgery. The aim of this study was to compare hospital outcomes between patients operated for chest wall injuries with a conventional method with large incisions and often a thoracotomy or a minimally invasive, muscle sparing method.

PATIENTS AND METHODS

A retrospective study was carried out including patients ≥18 years operated for chest wall injuries 2010-2020. Patients were divided into two groups based on the surgery performed: conventional surgery (C-group) and minimally invasive surgery (M-group). Data on demographics, trauma, surgery, and outcomes were extracted from patient records. Primary outcome was length of stay on mechanical ventilator (MV-LOS). Secondary outcomes were length of stay in intensive care (ICU-LOS) and in hospital (H-LOS), and complications such as re-operation, incidence of empyema, tracheostomy, pneumonia, and mortality.

RESULTS

Of 311 included patients, 220 were in the C-group and 91 in the M-group. The groups were similar in demographics and injury pattern. MV-LOS was 0 (0-65) in the C-group vs 0 (0-34) in the M-group (p < 0.001). ICU-LOS and H-LOS were significantly shorter in the M-group as compared to the C-group (p < 0.001), however with a large overlap. Tracheostomy was performed in 22.3% of patients in the C-group vs 5.4% in the M-group (p < 0.001). Pneumonia was diagnosed in 32.3% of patients in the C-group vs 16.1% in the M-group (p = 0.004). In-hospital mortality was lower in the M-group compared to the C-group but there was no difference in mortality within 30 days or a year.

CONCLUSIONS

Our study indicates that a minimally invasive technique was favorable regarding clinical outcomes for patients operated for chest wall injuries.

摘要

背景

胸壁损伤的外科治疗是一种常见的手术。然而，手术技术多种多样，且不存在通用的指南。缺乏关于比较胸壁手术不同手术技术疗效的研究。本研究的目的是比较采用传统大切口且常需开胸手术的方法与微创、保留肌肉的方法治疗胸壁损伤患者的住院结局。

患者与方法

进行了一项回顾性研究，纳入2010年至2020年因胸壁损伤接受手术的18岁及以上患者。根据所进行的手术将患者分为两组：传统手术组（C组）和微创手术组（M组）。从患者记录中提取人口统计学、创伤、手术及结局的数据。主要结局是机械通气时间（MV-LOS）。次要结局是重症监护病房住院时间（ICU-LOS）和住院时间（H-LOS），以及再次手术、脓胸发生率、气管切开术、肺炎和死亡率等并发症。

结果

在纳入的311例患者中，C组220例，M组91例。两组在人口统计学和损伤模式方面相似。C组的MV-LOS为0（0 - 65）天，M组为0（0 - 34）天（p < 0.001）。与C组相比，M组的ICU-LOS和H-LOS显著缩短（p < 0.001），但有较大重叠。C组22.3%的患者进行了气管切开术，M组为5.4%（p < 0.001）。C组32.3%的患者被诊断为肺炎，M组为16.1%（p = 0.004）。M组的院内死亡率低于C组，但30天内或1年内的死亡率无差异。