ENDOSURGICAL TECHNOLOGY FOR CHEST WOUNDS
Abstract
BACKGROUND Penetrating chest injuries are a common cause of hospitalization for young patients.Various types of thoracotomy prevails over the other surgical approaches performed both under absolute and relative indications, depending on the location of wounds.
PURPOSE To analyze the tactics and evaluate the possibility of thoracoscopy in order to reduce the number of unreasonable thoracotomies and reduce trauma due to surgical intervention.
MATERIAL AND METHODS We studied 596 medical histories of victims who had been operated in 2002–2012. Thoracoscopy was performed in 236 patients, traditional tactics was applied in 360 victims. Wounds in the diaphragmatic area of the chest were in 210 victims, in the “heart” area — in 172 patients, in the intersection of these two zones — 44 cases, in the projection of the lung peripheral part — 49 cases and paravertebral area of the chest — in 52 patients. Typical thoracotomy (TT) was performed in 27% of cases, atypical thoracotomy (AT) — 42.5%, and drainage of the pleural space (DPS) — 30.3% of cases.
RESULT Thoracoscopy (TS) could be carried out in 42.2% of patients who had undergone TT, and in 79.4% of patients who had undergone AT. Overall performance of the TS was possible in 70% of patients with penetrating chest wounds (PCW). Absolute contraindications for TS occurred in 29.1% of the victims.
About the Authors
O. V. Voskresensky
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department, Moscow, Russian Federation
Russian Federation
Russian Federation
M. M. Abakumov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department, Moscow, Russian Federation
Russian Federation
Russian Federation
References
1. Demetriades D., Velmahos G.C. Penetrating injuries of the chest: indications for operation. Scand J Surg. 2002; 91 (1): 41–45.
2. Renz B.M., Feliciano D.V. Gunshot wounds to the right thoracoabdomen: A prospective study of nonoperative management. J Trauma. 1994; 37 (5): 737–744.
3. Reece I.J., Davidson K.G. Emergency surgery for stab wounds to the heart. Ann R Coll Surg Engl. 1983; 65 (5): 304–307.
4. Cothren C.C., Moore E.E. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006; 1: 4.
5. Sotnichenko B.A., Glushko V.I., Makarov V.I., et al. Taktika khirurga pri otkrytykh sochetannykh povrezhdeniyakh grudi mirnogo vremeni [The tactics of the surgeon at the open combined injuries of chest in peacetime]. Byulleten’ VSNTs SO RAMN. 2007; 4: 111–114. (In Russian).
6. Ashraf S.S., Volans A.P., Sharif H., et al. The management of stab wounds to the chest: sixteen years’ experience. J R Coll Surg Edinb. 1996; 41(6): 379–381.
7. Gambazzi F., Schirren J. Thoracic drainage. What is evidence based? Chirurg. 2003; 74 (2): 99–107.
8. Abakumov M.M., Isfakhani A.K. Khirurgicheskaya taktika pri nozhevykh levostoronnikh torakoabdominal’nykh raneniyakh [Surgical approach in left-sided thoracoabdominal stab wounds]. Vestnik khirurgii im II Grekova. 1997; 156 (1): 86–90. (In Russian).
9. Uribe R.A., Pachon C.E., Frame S.B., et al. A prospective evaluation of thoracoscopy for the diagnosis of penetrating thoracoabdominal trauma. J Trauma. 1994; 37 (4): 650–654.
10. Murray J.A., Demetriades D., Cornwell E.E. 3rd, et al. Penetrating left thoracoabdominal trauma: the incidence and clinical presentation of diaphragm injuries. J Trauma. 1997; 43 (4): 624–646.
11. Leppaniemi A., Haapiainen R. Occult diaphragmatic injuries caused by stab wounds. J Trauma. 2003; 55 (4): 646–650.
12. Kutushev F.Kh., Korolev M.P., Sagatinov R.S., Michurin N.V. Diagnostika i khirurgicheskaya taktika pri raneniyakh serdtsa i perikarda [Diagnostics and surgical tactics in wounds of the heart and pericardium]. Vestnik khirurgii im II Grekova. 1995; 1: 72–74.
13. DeGennaro V.A., Bonfils-Roberts E.A., Ching N., Nealon T.F. Jr. Aggressive management of potential penetrating cardiac injuries. J Thorac Cardiovasc Surg. 1980; 79 (6): 833–837.
14. Goiti J.J., Smith G.H. Emergency surgery for stab wound to the heart. Ann R Coll Surg Engl. 1984; 66 (3): 221–222.
15. Pons F., Lang-Lazdunski L., de Kerangal X., et al. The role of videothoracoscopy in management of precordial thoracic penetrating injuries. Eur J Cardiothorac Surg. 2002; 22 (1): 7–12.
16. Valentine C., East J. Subxiphoid pericardial window in stable cardiac proximity injuries. West Indian Med J. 2003; 52 (4): 296–299.
17. Navsaria P.H., Nicol A.J. Video-assisted thoracoscopic pericardial window for penetrating cardiac trauma. S Afr J Surg. 2006; 44 (1): 18–20.
18. Thorson C.M., Namias N., Van Haren R.M., et al. Does hemopericardium after chest trauma mandate sternotomy? Trauma Acute Care Surg. 2012; 72 (6): 1518–1524; discussion 1524-1525.
19. Nicol A.J., Navsaria P.H., Hommes M., et al. Sternotomy or drainage for a hemopericardium after penetrating trauma: a randomized controlled trial. Ann Surg. 2014; 259 (3): 438–442.
20. Martinez M., Briz J.E., Carillo E.N. Video thoracoscopy expedites the diagnosis and treatment of penetrating diaphragmatic injuries. Surg Endosc. 2001; 15 (1): 28–32.
21. Förster R., Storck M., Schäfer J.R., et al. Thoracoscopy versus thoracotomy:
22. a prospective comparison of trauma and quality of life. Langenbeck’s Arch Surg. 2002; 387 (1): 32–36.
23. Voskresenskiy O.V., Abakumov M.M., Radchenko Yu.A. Znachenie shokovogo indeksa Al’govera v vybore khirurgicheskoy taktiki pri ranenii grudi [The value of Allgower’s shock index in the choice of surgical approach for chest wound]. Khirurgiya. 2009; 12: 43–48. (In Russian).
24. Voskresensky O.V. Kriterii bezopasnogo vypolneniya torakoskopii u postradavshikh s raneniem grudi [Criteria for the safe performance of videothoracoscopy in patients with chest wound]. Zhurnal im N V Sklifosovskogo Neotlozhnaya meditsinskaya pomoshch’. 2015; 1: 33–37. (In Russian).
25. Abakumov M.M. Mnozhestvennye i sochetannye raneniya shei, grudi, zhivota [The multiple and combined injuries of the neck, chest, abdomen]. Moscow: Binom-Press Publ., 2013. 688 p. (In Russian).
26. Abakumov M.M., Voskresenskiy O.V., Zhestkov K.G. Torakoskopiya v lechenii vnutriplevral’nogo krovotecheniya pri raneniyakh sosudov grudnoy stenki [Thoracoscopy in the treatment of intrapleural bleeding wounds of the chest wall vessels]. Khirurgiya. 2007; 2: 4–9. (In Russian).
27. Abakumov M.M., Voskresenskiy O.V., Zhestkov K.G. Torakoskopiya v diagnostike i lechenii raneniy legkogo [Thoracoscopy in the diagnosis and treatment of lung wounds]. Khirurgiya. 2007; 10: 4–9. (In Russian).
28. Vagner E.A. Pronikayushchie raneniya grudi [Penetrating chest wounds]. Moscow: Meditsina Publ., 1975. 177 p. (In Russian).28. Morales C.H., Salinas C.M., Henao C.A., et al. Thoracoscopic pericardial window and penetrating cardiac trauma. J Trauma. 1997; 42 (2): 273–275.
Review
For citations:
Voskresensky O.V., Abakumov M.M. ENDOSURGICAL TECHNOLOGY FOR CHEST WOUNDS. Russian Sklifosovsky Journal "Emergency Medical Care". 2016;(1):45-53.
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