Lurin Igor, Khoroshun Eduard, Negoduiko Volodymyr, Makarov Volodymyr, Shypilov Serhii, Boroday Volodymyr, Gorobeiko Maksym, Dinets Andrii
National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
State Administrative Department, State Institution of Science "Research and Practical Center of Preventive and Clinical Medicine, Kiev, Ukraine.
Int J Emerg Med. 2023 Aug 24;16(1):51. doi: 10.1186/s12245-023-00527-8.
Gunshot wounds injury to the thorax is common in armed conflicts or war, including the war of Russia against Ukraine. Injury to the chest is associated with a high mortality or physical disability due to damage to the lungs, heart, and major vessels. The aim of this report is to demonstrate a case of successful management of severe gunshot injury to the lungs using video-assisted thoracoscopic surgery and magnetic tool for a combat patient injured in the war in Ukraine.
A 51-year-old soldier of the Armed Forces of Ukraine received a gunshot injury due to shelling from artillery strikes in the Donbas battlefield area. After evacuation to Level II, a forward surgical team performed primary surgical debridement. Two hours after the injury, the patient was evacuated to the Level IV of medical care (Kharkiv). At Level IV, a CT scan showed penetrating gunshot wounds to the left part of the chest with injury to the upper lobe of the left lung with the presence of the 2 metal fragments of the artillery projectile with the size of 2.5 × 2.0 cm and 1.0 × 1.0 cm. These two fragments were removed by using video-assisted thoracoscopic surgery (VATS) using the inlet gunshot hole in the left lateral chest area, as well as the assistance of a magnetic tool.
VATS and magnetic technologies should be considered for hemodynamically stable combat patients with a gunshot injury to the lungs in the ongoing war. Each combat patient could be treated by individualized approach such as using the wound canal as a scope port after primary surgical debridement of the wound and antibiotic prophylaxis.
胸部枪伤在武装冲突或战争中很常见，包括俄罗斯与乌克兰的战争。胸部受伤由于肺部、心脏和主要血管受损，会导致高死亡率或身体残疾。本报告的目的是展示一例使用电视辅助胸腔镜手术和磁性工具成功治疗严重肺部枪伤的病例，该患者为一名在乌克兰战争中受伤的战斗人员。
一名51岁的乌克兰武装部队士兵在顿巴斯战场地区遭炮击而受枪伤。后被转移至二级医疗机构，前方手术团队进行了初步外科清创。受伤两小时后，患者被转移至四级医疗机构（哈尔科夫）。在四级医疗机构，CT扫描显示左胸穿透性枪伤，左肺上叶受损，有两块大小为2.5×2.0厘米和1.0×1.0厘米的炮弹金属碎片。通过在左外侧胸部区域利用入口枪伤孔，借助电视辅助胸腔镜手术（VATS）以及磁性工具，取出了这两块碎片。
对于正在进行的战争中肺部枪伤且血流动力学稳定的战斗人员，应考虑采用电视辅助胸腔镜手术和磁性技术。对于每一名战斗伤员，可采用个性化方法进行治疗，如在伤口初步外科清创后将伤口通道用作观察孔并进行抗生素预防。
