Role of Video-assisted Thoracic Surgery in management of Penetrating Thoracoabdominal Injuries
- VernacularTitle:电视胸腔镜在穿透性胸腹联合伤中的应用
- Author:
Jian ZHANG
;
Liang YU
;
Hao CHANG
- Publication Type:Journal Article
- Keywords:
Video-assisted thoracic surgery;
Wounds,Penetrating;
Thoracoabdominal;
Diagnosis;
Therapeutics
- From:
Chinese Journal of Minimally Invasive Surgery
2005;0(07):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the value of video-assisted thoracic surgery(VATS)for penetrating thoracoabdominal injuries.Methods Under general anaesthesia and double-lumen tracheal intubation,VATS was carried out to examine patients with chest injuries.Those who had mild injuries received VATS combined with mini-incision surgery.Electrocoagulation or suturing was employed to control intraoperative bleeding,and then blood clots were removed.Injured diaphragm muscles were repaired,and organs with hemorrhage or ruptures were sutured or resected.The seriously injured cases underwent open surgery and intra-abdominal exploration instead.Results A total of 18 patients received the operations.Among them,15 patients underwent VATS combined with mini-incision surgery(repair of the diaphragm was performed on 15,controlling intercostal arterial bleeding on 8,repair of the lung on 2,wedge resection of the lung on 2,and coagulated hemothorax removal on 2),the other 3 were converted to open surgery for repairing the diaphragm(3),heart(1),or esophagus(1),or lobectomy(2).Abdominal surgery via the thorax were performed on 13 cases,including repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 1,repair of diaphragmatic hernia in 3,and intra-abdominal exploration in 7.Five patients received open surgery(pancreatic neoplasty in 1,repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 2,and repair of the caul and mesenterium in 3).One patient who had multi-organ penetrating injuries died of hemorrhagic shock,circulatory failure,and DIC after open thoracic and abdominal surgeries.The mean operation time in this series was(125?44)minutes(ranged from 45 to 220),and the mean blood loss was(1089?582)ml(500 to 10 000 ml).Twenty-four hours after the operation,the mean volume of chest drainage was(234?75)ml(100 to 350 ml)in the first 24 hours after the operation.The chest drainage tube was withdrawn 2.5(2 to 5)days postoperation.The patients expelled gas in 1 to 4 days(mean,2 days).Totally,12 patients were followed up for 3 to 12 months(mean,6 months),during which none of them had trauma-related complications.Conclusion VATS combined with mini-incision surgery is safe and effective for patients with thoracoabdominal injuries,if the cases were carefully selected.
