胸部刀刺伤后膈肌损伤的胸腔镜探查诊治  

Thoracoscopic diagnosis and management of diaphragmatic injury after thoracoabdominal stabwound

作　　者：任迎春[1] 曹丽娟[1] 黄刚[1] 张萌[1] 周志刚[1] 牛晓光[1] 张鑫[1] 杨金良[1] 

机构地区：[1]河北医科大学第三医院胸外科,石家庄050051

出　　处：《中华创伤杂志》2012年第11期979-982,共4页Chinese Journal of Trauma

摘　　要：目的探讨胸腔镜诊断治疗胸腹部刀刺伤所致膈肌损伤的效果。方法回顾性研究2000年4月-2011年10月68例胸腔镜探查术诊治的胸腹部刀刺伤所致膈肌损伤患者。结果胸腔镜探查术发现11例隐匿性膈肌损伤，其中7例经胸腔镜直接修补后5例需同期剖腹探查腹腔脏器损伤。68例中，15例出现肺组织切割伤并通过胸腔镜修补或切除，13例清除凝固性血胸。术后并发症发生仅残留胸腔积液1例，肺炎2例，肺不张1例。住院时间（7．9．4-13．5）d，无ICU停留，引流时间（3．3±1．5）d，手术时间（45．6±78．1）min，术中出血量（57．8±24．3）ml。无中转开胸患者。术后6个月复查胸部CT未发现膈疝。本组患者胸腔镜探查膈肌损伤诊断率为100％。结论对于血流动力学稳定的胸腹部刀刺伤应积极行胸腔镜探查，尤其是刀刺伤位于第7～9肋间患者行胸腔镜探查具有明确的膈肌损伤诊断和治疗意义。Objective To analyze effects of thoracoscopy in the diagnosis and treatment of sus- pected diaphragmatic injury after thoracoabdominal stab wound. Methods Sixty-eight patients who re- ceived thoracoscopic diagnosis and management of diaphragmatic injuries due to thoracoabdominal stab wounds from April 2000 to October 2011 were retrospectively analyzed. Results Occult diaphragmatic injuries were found in 11 patients. Seven patients underwent thoracoscopic suture, of which five had syn- chronous laparotomy for inspected abdominal organ injuries. Pulmonary parenchymal lacerations occurred in 15 patients who received thoracoscopic repair or resection. Coagulated hemothorax in 13 patients were removed. Postoperative complications included pleural effusion in one patient, pneumonia in two and pul- monary atelectasis in one. Hospital stay was （7.9 ± 13.5） days, without ICU stay. The length of drain- age, operation time and intraoperative blood loss were （3.3 ± 1.5 ） days, （45.6 ± 78.1 ） minutes and （57.8 ± 24.3 ） ml respectively. There was no conversion to thoracotomy. Thoracic CT scan was per- formed six months postoperatively, without hernias. The accuracy of thoracoscopy in diagnosing diaphrag- matic injury was 100%. Conclusion Thoracoscopy should be performed for the thoracoabdominal stab wounds with stable hemodynamics, with definite significance especially for the diagnosis and treatment of wounds at the 7-9th intercostal spaces.

关 键 词：创伤 刺戳 胸部损伤 胸腔镜 

分 类 号：R655[医药卫生—外科学]