VIDEOTHORACOSCOPY FOR CLOTTED HEMOTHORAX IN PATIENTS WITH PENETRATING CHEST TRAUMA
Abstract
BACKGROUND. Clotted hemothorax is the most common complication of the chest injury requiring surgical treatment in most patients.
MATERIAL AND METHODS. Videothoracoscopy was performed in 51 patients with complications of penetrating chest trauma in 2011–2012. Clotted hemothorax occured in 27 cases (52.9%).
RESULTS. It was found that the main cause of this complication was inadequate pleural drainage effect. Clotted hemothorax developed after drainage of the pleural cavity and primary surgical debridement in 12 patients (44.4%), in 8 patients (29.6%) after atypical thoracotomy and in 7 patients (25.9%) after typical thoracotomy. The average interval between operations was 8.1±5.0 days.
CONCLUSION. The best results of treatment for clotted hemothorax were achieved under the early detection of clotted hemothorax in case of thoracoscopic evacuation in the range from 3 to 7 days (4.7±2.1). Videothoracoscopy performed more than 7 days after detection may increase the volume of surgery, cause significant complications, and considerably prolong treatment.
About the Authors
O. V. Voskresensky
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow Healthcare Department, Moscow
Russian Federation
Russian Federation
Sh. N. Daniyelian
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow Healthcare Department, Moscow
Russian Federation
Russian Federation
M. M. Abakumov
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow Healthcare Department, Moscow
Russian Federation
Russian Federation
References
1. Байдан В.Н. Ранняя торакотомия как метод выбора лечения свернувшегося гемоторакса // Клиническая хирургия. – 1987. – № 10. – С. 30–31. Baydan V.N. Rannyaya torakotomiya kak metod vybora lecheniya svernuvshegosya gemotoraksa [Early thoracotomy as the method of choice for treatment of coagulated hemothorax]. Klinicheskaya khirurgiya. 1987;10: 30–31. (In Russian).
2. Грубник В.В., Шипулин П.П., Байдан В.В. и др. Роль видеоторакоскопических операций в лечении поздних осложнений повреждения груди // Клiнiчна хiрургiя. – 2009. – № 6. – С. 34–36. Grubnik V.V., Shipulin P.P., Baydan V.V., et al. Rol’ videotorakoskopicheskikh operatsiy v lechenii pozdnikh oslozhneniy povrezhdeniya grudi [The role of videothoracoscopic surgery in the treatment of late complications of chest injuries]. Klinichna khirurgiya. 2009; 6: 34–36. (In Russian).
3. Ермолов А.С., Абакумов А.М., Погодина А.Н. и др. Диагностика и лечение посттравматического свернувшегося гемоторакса // Хирургия. – 2002. – № 10. – С. 4–9. Ermolov A.S., Abakumov A.M., Pogodina A.N., et al. Diagnostika i lechenie post-travmaticheskogo svernuvshegosya gemotoraksa [Diagnosis and treatment of post-traumatic coagulated hemothorax]. Khirurgiya. 2002; 10: 4–9. (In Russian).
4. Abolhoda A., Livingston D.H., Donahoo J.S., Allen K. Diagnostic and therapeutic video assisted thoracic surgery following chest trauma // Eur. J.Cardiothorac. Surg. – 1997. – Vol. 12, N. 3. – P. 356–360.
5. Ahmed N., Chung R. Role of early thoracoscopy for management of penetrating wounds of the chest // Am. Surg. – 2010. – Vol. 76, N. 11. – P. 1236–1239.
6. Ambrogi M.C., Lucchi M., Dini P. Videothoracoscopy for evaluation and treatment of hemothorax // J. Cardiovasc. Surg (Torino). – 2002. – Vol. 43, N. 1. – P. 109–112.
7. 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. – V. 41, N. 6. – P. 379–381. 8. Baumann M.H. What size chest tube? What drainage system is ideal? And other chest tube management questions // Curr. Opin. Pulm. Med. – 2003. – Vol. 9, N. 4. – P. 276–281.
8. Boersma W.G., Stigt J.A., Smit H.J. Treatment of haemothorax // Respir. Med. – 2010. – Vol. 104, N. 11. – P. 1583–1587.
9. Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients // Eur. J. Cardiothorac. Surg. – 2002. – Vol. 22, N. 5. – P. 673– 678.
10. Emergency War Surgery Third United States Revision 2004 / eds. A.C. Szul, L.B. Davis, B.G. Maston, et al. – Washington: Walter Reed Army Medical Center Borden Institute, 2004. – 488 р. – (Textbooks of Military Medicine).
11. Fitzgerald M., Mackenzie C.F., Marasco S., et al. Pleural decompression and drainage during trauma reception and resuscitation // Injury. – 2008. – Vol. 39, N. 1. – P. 9–20.
12. Gambazzi F.,Schirren J. Thoracic drainage. What is evidence based? // Chirurg. – 2003. – Vol. 74, N. 2. – P. 99–107.
13. Hoth J.J., Burch P.T., Richardson J.D. Posttraumatic Empyema // Eur. J. Trauma. – 2002. – Vol. 28, N. 6. – P. 323–332.
14. Inaba K., LustenbergerT., Recinos G., et al. Does size matter? A prospective analysis of 28–32 versus 36–40 French chest tube size in trauma // J. Trauma Acute Care Surg. – 2012. – Vol. 72, N. 2. – P. 422–427.
15. Leigh-Smith S., Harris T. Tension pneumotorax — time for a re-think? // Emerg. Med. J. – 2005. – Vol. 22, N. 1. – P. 8–16.
16. Meyer D.M., Jessen M.E., Wait M.A., Estrera A.S. Early evacuation of traumatic retained hemothoracesusing thoracoscopy: aprospective, randomized trial // Ann.Thorac. Surg. –1997. – Vol. 64, N. 5. – P. 1396– 1400.
17. Menger R., Telford G., Kim P., et al. Complications following thoracic trauma managed with tube thoracostomy // Injury. – 2012. – Vol. 43, N. 1. – P. 46–50.
18. Muslim M., Bilal A., Salim M., et al. Tube thorocostomy: management and outcome in patients with penetrating chest trauma //J. Ayub. Med. Coll. Abbottabad. – 2008. – Vol. 20, N. 4. – P. 108–111.
19. Navsaria P.H., Vogel R.J., Nicol A.J. Thoracoscopic evacuation of retained posttraumatic hemothorax// Ann. Thorac. Surg. – 2004. – Vol. 78, N. 1. – P. 282–285.
Review
For citations:
Voskresensky O.V., Daniyelian Sh.N., Abakumov M.M. VIDEOTHORACOSCOPY FOR CLOTTED HEMOTHORAX IN PATIENTS WITH PENETRATING CHEST TRAUMA. Russian Sklifosovsky Journal "Emergency Medical Care". 2015;(2):35-40.
Views:
925
Email this article 