胸部穿透伤伴异物存留诊治分析  

A retrospective analysis for chest penetrating injury with foreign body retention

作　　者：林曦[1] 都定元[1] 高劲谋[1] 胡平[1] 

机构地区：[1]重庆市急救医疗中心,重庆市急救医学研究所,重庆400014

出　　处：《创伤外科杂志》2016年第1期10-14,共5页Journal of Traumatic Surgery

基　　金：国家“十二五”科技支撑计划资助项目(2012BAI11B01);重庆市科委自然科学基金(重点)资助项目(CSTC2012jj B10021);重庆市卫生局医学科学技术研究重点资助项目(2010-1-52,2011-2-378)

摘　　要：目的总结胸部穿透伤伴异物存留的救治经验,进一步提高诊治水平。方法笔者回顾性分析1997年1月~2015年5月收治的胸部穿透伤伴异物存留28例患者的临床资料,其中男性24例,女性4例;年龄15~64岁,平均43.5岁。受伤至入院时间20min^37h,平均52.4min。结果本组28例患者均急诊行剖胸探查及异物取出术,剖胸手术入路选择前外侧切口14例(50.00%),后外侧切口7例(25.00%),锁骨及第1、2肋切断3例(10.72%),胸骨正中切口2例(7.14%),胸腹联合切口2例(7.14%);脏器损伤51例次,其中肺裂伤22例次(43.14%),心脏大血管伤5例次(9.80%),肋间动脉伤5例次(9.80%),脊柱及纵隔伤4例次(7.84%),膈肌伤8例次(15.69%),胸导管1例次(1.96%),腹腔脏器伤6例次(11.77%)。对损伤脏器均行一期确定性手术,包括肺裂伤切开深部止血后缝合、心脏大血管修补缝合、肋间动脉缝扎止血、纵隔血肿清除、膈肌修补、胸导管结扎以及肝脏、胃修补和脾切除。27例(96.43%)异物完全取出,1例(3.57%)部分异物残留,死亡2例(7.14%)。结论术前恰当的生命支持、术中针对性选择切口、明确人员分工、合理的手术操作是治疗胸部穿透伤伴异物存留成功的关键。Objective To summarize the experiences of diagnosis and treatment for chest penetrating injury with foreign body retention and to make further improvement of the outcomes. Methods A retrospective analysis was made on clinical data of 28 patients with chest penetrating injury with foreign body rentention in Chongqing E- mergency Medical Center from Jan. 1997 to May 2015. There were 24 males and 4 females,with age ranged from 15-64 years （ average,43.5 years old）. Admission time after injury ranged from 20 minutes to 37 hours,with an av- erage of 52.4 minutes. Results All these 28 patients accepted both exploratory thoracotomy and foreign body re- moval operation. The surgical approach choices included 14 patients with anterolateral thoracotomy incision（50% ） , 7 patients with posterolateral thoracotomy incision（ 25 % ） ,3 patients with the thoracotomy incision by collarbone and the 1st and 2nd rib cutting-off（ 10. 72% ） ,2 patients with sternotomy（7.14% ） ,and 2 patients with thoracoabdomi- hal incision（7.14% ）. There were 51 cases of viscera damage,including 22 cases of lung lacerationg3.14% ） ,5 cases of heart and great vascular injury{ 9. 80% ） ,5 cases of intercostal artery injury（ 9. 80% ） ,8 cases of diaphrag- matic muscle injury（ 15.69% ） ,4 cases of spine and mediastinum injury（7.84% ） ,1 case of ductus thoracicus inju- ry（1.96%） ,and 6 cases of abdominal viscera injury（11.77%）. All the damaged viscera were performed one - stage definitive operation, such as hemostasis and suture repair after pneumonotomy, heart and great vascular lacera- tion suture repair, intercostals arteries hemostasis, mediastinum hematoma removal, diaphragmatic repair, ductus tho- racicus ligation ,liver repair, gastrorrhaphy, and splenectomy. In this group, 27 cases achieved perfect foreign body removal（96. 43% ） and 1 case achieved foreign body retention（3.57% ）. Two cases died（7.14% ）. Conclusion Proper preoperative life support, targeted incision approach choice, expl

关 键 词：胸部损伤 穿透伤 剖胸探查 异物 

分 类 号：R655[医药卫生—外科学]