Divisi Duilio, Zaccagna Gino, De Sanctis Stefania, Vaccarili Maurizio, Di Leonardo Gabriella, Lucchese Adele, De Vico Andrea
Department of Life, Health and Environmental Sciences, Thoracic Surgery Unit, University of L'Aquila, L'Aquila, Italy.
Updates Surg. 2025 Sep;77(5):1295-1304. doi: 10.1007/s13304-024-02003-1. Epub 2024 Sep 30.
Video-assisted thoracoscopy (VAT) plays an essential role in the exploration of pleural cavity after thoracic trauma, although some doubts about the precise and specific indications persist. This study examines the eligibility criteria for videothoracoscopy and establishes the ideal timing for VAT. Between January 2011 and November 2022, we observed 923 polytraumatized patients. All patients underwent computed tomography (CT) scan total body with and without contrast enhancement. Two hundred and nine patients carried out VAT within 10 ± 2 h of injury while 8 patients after 20 ± 1 h. The Injury Severity Score (ISS) was 31 ± 1 and the Glasgow Coma Scale was 14.1 ± 0.3 upon arrival at the hospital. One hundred and nineteen patients displayed hemothorax (55%), 62 hemopneumothorax (28.5%), 21 penetrating wound (9.6%), 10 pneumothorax (4.6%) and 5 chylothorax (2.3%). In 18 patients (8.3%) without vascular, diaphragmatic, or parenchymal lesion the treatment consisted in chest tube placement. VAT was converted to video-assisted thoracoscopic surgery (VATS) in 190 patients (87.5%), to open surgery in 8 (3.7%) and to laparoscopy in 1 (0.5%). Twelve patients (5.5%) with diaphragm ruptures < 5 cm in diameter were treated by separate stitches suture in VATS. Only eight postoperative complications (4 pneumonia, three atelectasis and one pulmonary embolism) out of 217 VAT, positively resolved with medical treatment, were noted exclusively in patients undergoing minimally invasive approach 20 ± 1 h after trauma. Early VAT in selected patients is a safe and easy procedure that ensure a quick diagnosis of lesions and an accurate management of the most thoracic injuries among trauma patients. The prompt identification of injuries, to avoid life-threatening conditions requiring rapid intervention, responds to medico-legal needs to which VAT fulfills.
电视辅助胸腔镜检查（VAT）在胸部创伤后胸腔探查中起着至关重要的作用，尽管对于其确切和具体的适应症仍存在一些疑问。本研究探讨了电视胸腔镜检查的入选标准，并确定了VAT的理想时机。在2011年1月至2022年11月期间，我们观察了923例多发伤患者。所有患者均接受了有无对比增强的全身计算机断层扫描（CT）。209例患者在受伤后10±2小时内进行了VAT，8例患者在20±1小时后进行。入院时损伤严重程度评分（ISS）为31±1，格拉斯哥昏迷量表评分为14.1±0.3。119例患者出现血胸（55%），62例血气胸（28.5%），21例穿透伤（9.6%），10例气胸（4.6%）和5例乳糜胸（2.3%）。18例（8.3%）无血管、膈肌或实质损伤的患者接受了胸腔闭式引流管置入治疗。190例患者（87.5%）的VAT转为电视辅助胸腔镜手术（VATS），8例（3.7%）转为开放手术，1例（0.5%）转为腹腔镜手术。12例直径<5cm的膈肌破裂患者在VATS中采用单独缝线缝合治疗。在217例VAT患者中，仅8例术后并发症（4例肺炎、3例肺不张和1例肺栓塞）通过药物治疗得到积极解决，这些并发症仅在创伤后20±1小时接受微创治疗的患者中出现。对选定患者进行早期VAT是一种安全、简便的操作，可确保快速诊断损伤并准确处理创伤患者中大多数胸部损伤。及时识别损伤以避免需要快速干预的危及生命的情况，符合VAT所满足的法医学需求。
