视频辅助胸腔镜在胸部创伤中的作用:单中心经验回顾。

IF 2.2 3区 医学 Q2 SURGERY
Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2024-09-30 DOI:10.1007/s13304-024-02003-1
Duilio Divisi, Gino Zaccagna, Stefania De Sanctis, Maurizio Vaccarili, Gabriella Di Leonardo, Adele Lucchese, Andrea De Vico
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引用次数: 0

摘要

视频辅助胸腔镜(VAT)在胸部创伤后胸膜腔的探查中发挥着至关重要的作用,但对其精确和具体的适应症仍存在一些疑问。本研究探讨了视频胸腔镜检查的资格标准,并确定了进行 VAT 检查的理想时机。2011 年 1 月至 2022 年 11 月期间,我们观察了 923 名多发性创伤患者。所有患者都接受了有对比剂增强和无对比剂增强的全身计算机断层扫描(CT)。抵达医院时,受伤严重程度评分(ISS)为 31 ± 1,格拉斯哥昏迷量表(Glasgow Coma Scale)为 14.1 ± 0.3。119 名患者出现血气胸(55%),62 名出现血气胸(28.5%),21 名出现穿透伤(9.6%),10 名出现气胸(4.6%),5 名出现乳糜胸(2.3%)。18名患者(8.3%)没有血管、膈肌或实质病变,治疗包括放置胸管。190名患者(87.5%)转为视频辅助胸腔镜手术(VATS),8名患者(3.7%)转为开胸手术,1名患者(0.5%)转为腹腔镜手术。12例(5.5%)横膈膜破裂患者
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The role of video-assisted thoracoscopy in chest trauma: a retrospective monocentric experience.

Video-assisted thoracoscopy (VAT) plays an essential role in the exploration of pleural cavity after thoracic trauma, although some doubts about the precise and specific indications persist. This study examines the eligibility criteria for videothoracoscopy and establishes the ideal timing for VAT. Between January 2011 and November 2022, we observed 923 polytraumatized patients. All patients underwent computed tomography (CT) scan total body with and without contrast enhancement. Two hundred and nine patients carried out VAT within 10 ± 2 h of injury while 8 patients after 20 ± 1 h. The Injury Severity Score (ISS) was 31 ± 1 and the Glasgow Coma Scale was 14.1 ± 0.3 upon arrival at the hospital. One hundred and nineteen patients displayed hemothorax (55%), 62 hemopneumothorax (28.5%), 21 penetrating wound (9.6%), 10 pneumothorax (4.6%) and 5 chylothorax (2.3%). In 18 patients (8.3%) without vascular, diaphragmatic, or parenchymal lesion the treatment consisted in chest tube placement. VAT was converted to video-assisted thoracoscopic surgery (VATS) in 190 patients (87.5%), to open surgery in 8 (3.7%) and to laparoscopy in 1 (0.5%). Twelve patients (5.5%) with diaphragm ruptures < 5 cm in diameter were treated by separate stitches suture in VATS. Only eight postoperative complications (4 pneumonia, three atelectasis and one pulmonary embolism) out of 217 VAT, positively resolved with medical treatment, were noted exclusively in patients undergoing minimally invasive approach 20 ± 1 h after trauma. Early VAT in selected patients is a safe and easy procedure that ensure a quick diagnosis of lesions and an accurate management of the most thoracic injuries among trauma patients. The prompt identification of injuries, to avoid life-threatening conditions requiring rapid intervention, responds to medico-legal needs to which VAT fulfills.

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来源期刊
Updates in Surgery
Updates in Surgery Medicine-Surgery
CiteScore
4.50
自引率
7.70%
发文量
208
期刊介绍: Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.
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