O'Brien J, Cohen M, Solit R, Solit R, Lindenbaum G, Finnegan J, Vernick J
Department of Surgery, Thomas-Jefferson University Hospital, Philadelphia, PA.
J Trauma. 1994 Apr;36(4):536-9; discussion 539-40. doi: 10.1097/00005373-199404000-00013.
The purpose of this study is to describe our experience with thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest trauma.
Over a 9-month period, eight patients at two institutions were treated for empyema thoracis that developed following penetrating chest injury. Seven patients sustained gunshot wounds and one a stab wound. All were treated for hemothorax with a closed tube thoracostomy. Associated injuries included six spinal cord injuries, a liver and diaphragmatic injury, a subclavian injury, and a carotid injury. Each patient subsequently developed an empyema. All patients underwent one thoracoscopic drainage and decortication of the empyema.
In all patients, complete resolution of the empyema was achieved with the thoracoscopic technique. Chest tubes were removed a median of 8.5 days after the procedure. Median blood loss was 200 mL. The average duration of the operation was 110 minutes. There were two complications, a persistent air leak and a trapped lung, both treated with thoracoscopic intervention.
Thoracoscopic drainage and decortication offers an alternative to thoracotomy for definitive therapy of empyema thoracis developing after penetrating chest trauma.
本研究旨在描述我们采用胸腔镜引流及纤维板剥脱术作为穿透性胸部创伤后脓胸的确定性治疗方法的经验。
在9个月的时间里，两家机构的8例患者接受了穿透性胸部损伤后发生的脓胸治疗。7例患者为枪伤，1例为刺伤。所有患者均通过胸腔闭式引流术治疗血胸。相关损伤包括6例脊髓损伤、1例肝脏和膈肌损伤、1例锁骨下损伤以及1例颈动脉损伤。随后，每位患者均发生了脓胸。所有患者均接受了一次胸腔镜下脓胸引流及纤维板剥脱术。
采用胸腔镜技术，所有患者的脓胸均完全消退。术后胸腔引流管中位拔除时间为8.5天。中位失血量为200 mL。平均手术时长为110分钟。出现了2例并发症，即持续性漏气和肺陷闭，均通过胸腔镜干预进行了治疗。
胸腔镜引流及纤维板剥脱术为穿透性胸部创伤后发生的脓胸的确定性治疗提供了开胸手术之外的另一种选择。
