초록접수 현황
| 15F-006 | 구연 발표 |
The Role of Video-assisted Thoracoscopic Surgery for Management of Traumatic Chest Wall Injury
김현구, 한국남, 이현주, 최영호
고려대학교 의과대학 구로병원 흉부외과학교실
Background : Blunt chest wall trauma are occasionally associated with rib fractures and internal thoracic organ damages. The painful and displaced fragments of fractured ribs or suspicious thoracic organ damages are potential indicator for surgical treatment. Nowadays, minimally invasive approach such as a video-assisted thoracoscopic surgery (VATS) has been attempted to obviate the need for a full thoracotomy in these cases. This study was to evaluate the role of VATS in the management for blunt chest wall trauma.
Methods : Fifty-eight patients (44 male, 14 female; age 56.5±10.8 years old) who had painful and displaced fragments of fractured ribs with protruding into the hemithorax on chest computed tomography resulting from blunt chest wall trauma from August 2012 to August 2015 were enrolled in this study. Video-assisted thoracoscopy was performed with two-lung ventilation with low tidal volume in all patients. A thoracoscope was introduced through the previous chest tube site and careful inspection was performed to find the displaced fragments of fractured ribs and the any other internal organ injuries. Minithoracotomy was made just above the rib fracture, and then lung or other internal organ injuries were repaired under guidance of thoracoscope, and rib fixations with metal plate were performed (Figure).
Results : Hemothorax was found in all patients (100%) and flail chest in 6 of 58 patients (10.3%). Thoracotomy could be minimized under the guidance of thoracoscope. Rib fixations were performed at 2.7±1.9 (range, 1~9) per patient and lung or diaphragmatic laceration were found in 24 of 58 patients (41.4%). Those injuries were successfully repaired under guidance of thoracoscope. The duration of indwelling chest tube was 7.8 ± 4.5 days (range, 2~23) after operation. There was no mortality except one patient who died of sepsis due to a fractured limb necrosis.
Conclusion : VATS may improve the surgeon’s ability to keep the external exposure to a minimum, make the careful inspection and repair of the internal organ injuries. This strategy of minimizing operative dissection could minimize postoperative morbidity.
Methods : Fifty-eight patients (44 male, 14 female; age 56.5±10.8 years old) who had painful and displaced fragments of fractured ribs with protruding into the hemithorax on chest computed tomography resulting from blunt chest wall trauma from August 2012 to August 2015 were enrolled in this study. Video-assisted thoracoscopy was performed with two-lung ventilation with low tidal volume in all patients. A thoracoscope was introduced through the previous chest tube site and careful inspection was performed to find the displaced fragments of fractured ribs and the any other internal organ injuries. Minithoracotomy was made just above the rib fracture, and then lung or other internal organ injuries were repaired under guidance of thoracoscope, and rib fixations with metal plate were performed (Figure).
Results : Hemothorax was found in all patients (100%) and flail chest in 6 of 58 patients (10.3%). Thoracotomy could be minimized under the guidance of thoracoscope. Rib fixations were performed at 2.7±1.9 (range, 1~9) per patient and lung or diaphragmatic laceration were found in 24 of 58 patients (41.4%). Those injuries were successfully repaired under guidance of thoracoscope. The duration of indwelling chest tube was 7.8 ± 4.5 days (range, 2~23) after operation. There was no mortality except one patient who died of sepsis due to a fractured limb necrosis.
Conclusion : VATS may improve the surgeon’s ability to keep the external exposure to a minimum, make the careful inspection and repair of the internal organ injuries. This strategy of minimizing operative dissection could minimize postoperative morbidity.
책임저자: 김현구
고려대학교 의과대학 구로병원 흉부외과학교실
연락처 : 김현구, Tel: 02-2626-3106 , E-mail : kimhyunkoo@korea.a.ckr
