ВведениеВидеоторакоскопия (ВТС) получает все боль-шее распространение в лечении повреждений груди. Применение этого метода способствует уменьше-нию хирургической травмы, снижению частоты ра-невых осложнений, сокращению длительности ле-чения и скорейшей реабилитации пострадавших [10,13,17,18]. Использование ВТС возможно у по-страдавших со стабильными показателями гемоди-намики и при объективной оценке тяжести вну-тренних повреждений [11,12,16]. Знание особенно-стей ранений органов и анатомических структур груди способствует обоснованному выбору вида оперативных вмешательств, при этом ВТС может стать одним из основных методов.Цель работы -на основании ретроспективной оценки тяжести повреждений и применения как традиционных, так и эндохирургических методов определить возможность использования ВТС при ранениях груди. Ключевые слова: ранение груди, шоковый индекс, видеоторакоскопия.It was analyzed the medical reports of 596 victims with thoracic injuries including 360 cases with following conventional therapeutic approach and 236 patients who underwent videothoracoscopy. We estimated condition severity in case of injuries of thoracic wall, lungs, pericardium and heart. Hemodynamic disorders were estimated according to Allgower-Burri shock index. Intrapleural bleeding was calculated using volume of hemothorax and time before injury and operation. Severity of physiological damages was determined using RTS criterion, anatomic -using ISS criterion. We estimated possibility for videothoracoscopy in patients with conventional therapeutic approach comparing severity of injuries, severity of condition in both groups and volume of surgery. Retrospective analysis revealed possibility of videothoracoscopy in 86.7% of victims with pulmonary injury, in 83.3% with bleeding at the muscular vessels of thoracic wall, in 40.3% with intercostal vessels injury, in 31.2% with heart injury, in 27.3% with damage of pericardium and in 18.8% with internal thoracic vessels injury. Our investigation revealed that videothoracoscopy may be used more widely in case of thoracic injury.
It was performed retrospective analysis of 463 cases of suppurative thoracic complications after injury (232) and closed thoracic trauma (231) for 20-year period. Incidence of purulent complications was 3.2% and 1.6% in case of injury and closed thoracic trauma respectively including pleural empyema in 1.5 and 1.3%, pulmonary abscess in 0.3 and 0.4%, mediastinitis in 0.35 and 0.12%, pericarditis in 1.5 and 0.26%, osteomyelitis in 0.4 and 0.18% respectively. Factors preceding suppurative complications in case of injuries and closed trauma have been considered as predictors. Multivariant regression analysis established significant risk factors of suppurative thoracic complications. Clotted hemothorax, mediastinal hemorrhage, heart injury, late appeal for medical assistance and mechanical ventilation over 5 days were identified irrespective of character of trauma. In case of thoracic injury there were damage of osteochondrous frame, hollow thoracic and abdominal organs, gunshot wound of lung, delirium and injuries severity over 20 scores according to ISS scale. Pulmonary bleeding, sternal fracture and Glasgow Coma Scale rate<12 scores were identified as risk factors in case of closed trauma.
In victims with thoracic injuries and no need for urgent thoracotomy video-assisted techniques are preferable for diagnosis and treatment.
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