Журнал травм и лечения

Urgent Thoracotomy for Blunt Chest Trauma

Abstract

Romaldas Rubikas and Abdul Rahman Maaliki

The majority of patients with blunt chest trauma are treated conservatively or using minor thoracic surgical procedures, and video-assisted thoracoscopic surgery. However, in a small but significant number of patients an urgent exploration of the chest via, thoracotomy is unavoidable. In those cases thoracotomy means not only a surgical incision, but the most invasive (aggressive) method used in the complex treatment of blunt chest trauma. The objectives of this study were the following: (2) to specify the indications for urgent thoracotomy, regarding the possibilities of video-assisted thoracoscopic surgery; [2] to reveal the main factors influencing outcomes following urgent thoracotomy. A retrospective review of 1,826 patients (age 40.3 ± 12.4, range 18 – 79 years) with blunt chest trauma over the period of 10 years (2002-2011) was performed. A detailed analysis was completed involving 102 (5.6%) patients who
underwent urgent thoracotomy. We recorded patients’ age and gender, the mechanism of injury, clinical condition, NISS, injuries of the chest, intrapleural hemorrhage (hemothorax) and air leakage (aeropathic syndrome), methods of treatment, mortality and morbidity occurring within 30 days following urgent thoracotomy. Student’s t and chisquared tests were used for the comparison of the data. The level of  statistical significance was set at p<0.05. Comparing to the previous period (1987-2000), video-assisted  horacoscopic surgery has reduced twice (to 5.6%) the incidence rate of urgent thoracotomy.  he overall postoperative morbidity and mortality rate was 65.7% and 8.8%, respectively. Video-assisted   horacoscopic approach is the method of choice for clinically stable patients. However, when surgical  intervention is unavoidable for clinically unstable patients, it should be started with urgent thoracotomy.  Multiple fractures of ribs and/or sternum that caused flail chest, injuries of lungs, and intensive  intrapleural hemorrhage, resulting in patient’s clinically unstable condition were the main factors  influencing morbidity and mortality following urgent thoracotomy due to blunt chest trauma.