Delibegovíc-Dedíc S, Budalica M, Bazardzanović M
Department of Surgery, Tuzla University Hospital, 75000 Tuzla, Bosnia and Herzegovina.
Croat Med J. 1998 Dec;39(4):442-5.
To assess the need for and significance of immediate thoracotomy compared to conservative treatment (thoracostomy and/or thoracocentesis) of penetrating chest injuries.
Retrospective analysis was performed on medical records of 743 war wounded patients treated for chest injuries in the Department of Surgery, University Hospital Tuzla, between January 1992 and December 1995. Minimally invasive (tissue saving) surgery was the most frequent method applied, which usually included sutures of the lungs after débridment of margins and hemostasis, followed by atypical resection.
Out of 743 patients, there were 414 (55. 7%) cases of immediate thoracotomy, whereas 295 (39.7%) who were treated conservatively, including thoracostomy and/or thoracocentesis. Twenty four (3.2%) patients died at admission, and 10 (1.3%) did not require any surgical treatment. The most frequent complications were secondary wound infection (10.8% in the conservative treatment group and 2. 5% in the group treated by thoracotomy), pleural effusion (19.3% in the conservatively treated group and 10.8% in the group treated by thoracotomy), and empyema (5. 1% in the conservatively treated group and 13.4% in the group treated by thoracotomy).
Our results are similar to those reported for other war situations but surgeries were very often performed on the basis of subjective judgements on the severity of the patient's clinical condition and necessity for thoracotomy.
评估与穿透性胸部损伤的保守治疗（胸廓造口术和/或胸腔穿刺术）相比，急诊开胸手术的必要性及意义。
对1992年1月至1995年12月在图兹拉大学医院外科接受胸部损伤治疗的743名战争伤员的病历进行回顾性分析。微创（组织保留）手术是最常用的方法，通常包括在清创边缘和止血后缝合肺部，然后进行非典型切除。
743例患者中，414例（55.7%）接受了急诊开胸手术，而295例（39.7%）接受了保守治疗，包括胸廓造口术和/或胸腔穿刺术。24例（3.2%）患者入院时死亡，10例（1.3%）无需任何手术治疗。最常见的并发症是继发性伤口感染（保守治疗组为10.8%，开胸手术组为2.5%）、胸腔积液（保守治疗组为19.3%，开胸手术组为10.8%）和脓胸（保守治疗组为5.1%，开胸手术组为13.4%）。
我们的结果与其他战争情况下报告的结果相似，但手术往往是基于对患者临床病情严重程度和开胸手术必要性的主观判断进行的。
