穿透性胸部损伤诊断和处理.doc

胸部穿透伤诊断和治疗方式的选择与探讨 刘朝普 高劲谋 胡平 李昌华 赵兴吉 重庆市急救医疗中心创伤科（400014） [摘要] 目的 探讨和总结胸部穿透伤的诊断方法和治疗经验。方法 回顾性分析我院2002年1月~2O12年12月收治穿透性胸部损伤612例患者的临床资料，包括损伤情况，诊断方法和治疗方式等。结果 伤口部位：左前胸壁155例，左后胸壁136例，右前胸壁138例，右后胸壁109例，双侧胸部22例；颈根部36例，上腹部16例。剖胸手术169例，胸腔镜手术26例，非手术治疗417例。治愈591例，出现并发症41例。死亡21例，其中手术组死亡9例：1例死于心脏伤；2例死于颈部血管伤；1例死于肺门血管伤；2例死于腹部合并伤；3例死于术后感染并发症和MODS。非手术组死亡12例，死亡原因为心脏伤1例，大血管伤7例，心脏合并大血管伤3例，气管断裂并出血窒息1例。结论 胸部穿透伤应依据伤口部位、伤道走向、伤道深度做出初步判断，选择多层螺旋CT检查对明确诊断较快捷准确。需要剖胸手术的患者，伤情严重，手术切口选择应以方便处理胸内最严重、最致命伤为原则。胸腔镜手术适于生命征稳定、较为简单的胸内脏器伤。 [关键词] 胸部创伤；穿透伤；诊断；治疗；手术 Explore and choice the diagnostic and management methods for penetrating chest trauma.LIU Chao-pu，GAO Jin-mou， HU-Ping，LI Chang-hua, ZHAO Xing-ji.Department of traumatology，Chongqing Emergency Medical Center ,Chongqing 400014，China Abstract： Objective To diagnostic methods and surgical management experience of penetrating chest trauma.Methods The clinical data of 612 patients in our department during the past 10 years were analyzed retrospectively in respects of features of injury,diagnostic methods, surgical management and outcome,etc.Results Location of the wounds：the wounds on the left anterior chest wall had 155 cases, on the left posterior chest wall 136 cases, on the right anterior chest 138 cases，on the right posterior chest 109 cases,on the bilateral chest 22 cases, on the root of the neck 36 cases, on the upper abdome 16 cases.169 underwent thoracotomy,26 underwent VATS（Video-assisted Thoracoscopic Surgery） non-operative-management.591 were cured,41cases developed complications. 21 were died.9 were died in operated group,1 died of penetrating cardiac trauma,2 died of associated neck great vessels injuries, 1 died of hilus jinjury of the lung， 2 died of associated abdominal injuries, 3 died of complications of ARDS and infection.In non-operative group, 1 died of cardiac trauma,7 died of large vessel injury, 3 died of cardiac associated large vessel injury,1 died of asphyxy due to tracheal rupture and bleeding. Conclusions The injury severi