■创伤性血胸约占创伤性胸部损伤的20%。尽管大多数可以通过及时放置肋间管(ICT)引流来管理,由于与保留的血胸相关的高并发症发生率,其余病例构成了挑战.尽管各种治疗方式,包括胸膜内滴注纤维蛋白溶解剂,射线图像引导引流,确实存在VATS引导的疏散和胸腔镜切除术来解决保留的血胸,但采用特定治疗方案的适应症和时机仍不清楚和模糊.
■在留置ICT48小时后超声检查时出现残余血胸(>200mL)的患者被随机分为早期电视胸腔镜手术(VATS)或常规方法队列。早期的VATS队列接受了电视辅助胸腔镜下不排水的血液排空以及生理盐水冲洗和ICT放置。常规队列连续3天接受胸膜内溶栓滴注。结果衡量标准是留置ICT的持续时间,胸廓置管切开率,住院时间,重症监护病房(ICU)监测的持续时间,需要机械通风,肺和胸膜并发症的发生率,以及需要额外的干预措施来解决未排水的血胸和死亡率。
■早期VATS队列的住院时间较短(7.50±0.85vs.9.50±3.03,P=0.060),减少留置ICT的持续时间(6.70±1.25vs.8.30±2.91,P=0.127),具有较高的胸廓置管切开率(70%vs.30%,P=0.003)和较少需要额外干预(0%与30%,P=0.105)。开胸手术(3例)和图像引导引流术(4例)是常规队列中治疗保留的血胸的额外干预措施。然而,呼吸机辅助的相似长度(0.7±0.48vs.0.60±1.08,P=0.791)和延长ICU监测(1.30±1.06vs.在VATS早期队列中观察到0.90±1.45,P=0.490)。这两个队列都没有死亡率。
■VATS指导的创伤性血胸的早期疏散与住院时间缩短以及留置ICT持续时间缩短有关,减少并发症的发生率,再入院次数较少,提高了胸腔置管切开率。然而,呼吸机需求的持续时间,ICU停留,死亡率保持不变。
UNASSIGNED: Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous.
UNASSIGNED: Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate.
UNASSIGNED: The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, P = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, P = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, P = 0.003) and lesser need of additional interventions (0% vs. 30%, P = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, P = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, P = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality.
UNASSIGNED: VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.