Mitchell M E, Muakkassa F F, Poole G V, Rhodes R S, Griswold J A
Department of Surgery, University of Mississippi Medical Center, Jackson 39216-4505.
J Trauma. 1993 Jan;34(1):17-20. doi: 10.1097/00005373-199301000-00003.
One hundred nineteen patients suffered penetrating cardiac trauma over a 15-year period: 59 had gunshot wounds, 49 had stab wounds, and 11 had shotgun wounds. The overall survival rate was 58%. The most commonly injured structures were the ventricles. Twenty-seven patients had injuries to more than one cardiac chamber. Thirty patients had associated pulmonary injuries. Emergency thoracotomy was performed in 47 patients with 15% survival. Median sternotomy was used in 30 patients with 90% survival. Seventeen of the 83 patients with thoracotomies required extension across the sternum for improved cardiac exposure or access to the contralateral hemithorax. Only one patient with sternotomy also required a thoracotomy. All pulmonary injuries were easily managed when sternotomy was used. We conclude that sternotomy provides superior exposure for cardiac repair in patients with penetrating anterior chest trauma. We feel it is the incision of choice in hemodynamically stable patients. Thoracotomy should be reserved for unstable patients requiring aortic cross-clamping, or when posterior mediastinal injury is highly suspected.
119例患者在15年期间遭受穿透性心脏创伤：59例为枪伤，49例为刺伤，11例为霰弹枪伤。总体生存率为58%。最常受伤的结构是心室。27例患者的不止一个心腔受伤。30例患者伴有肺部损伤。47例患者进行了急诊开胸手术，生存率为15%。30例患者采用正中胸骨切开术，生存率为90%。83例行开胸手术的患者中有17例需要延伸切开胸骨以改善心脏暴露或进入对侧半胸。只有1例行胸骨切开术的患者也需要开胸手术。采用胸骨切开术时，所有肺部损伤都很容易处理。我们得出结论，胸骨切开术为穿透性前胸部创伤患者的心脏修复提供了更好的暴露。我们认为它是血流动力学稳定患者的首选切口。开胸手术应保留给需要主动脉交叉钳夹的不稳定患者，或高度怀疑有后纵隔损伤时。
