603例胸部穿透伤的诊断与治疗分析

Analysis of the diagnosis and management of penetrating chest trauma in 603 cases

目的：总结胸部穿透伤的诊断方法和治疗经验。方法回顾性分析该院2003～2013年收治的603例穿透性胸部损伤患者的临床资料，包括损伤情况、诊断方法和治疗方式等。结果伤口部位：左前胸壁151例，左后胸134例，右前胸137例，右后胸108例，双侧胸部22例；颈根部35例，上腹部16例。C T检查453例，阳性率96．03％；X线片检查252例，阳性率71．03％；彩色超声检查93例，阳性率62．37％。手术治疗192例，其中，剖胸手术166例，胸腔镜下手术26例；非手术治疗411例。出现并发症76例，死亡20例，治愈583例，治愈率96．68％。结论胸部穿透伤应用多层螺旋C T检查能快捷明确诊断；剖胸手术切口选择应以方便处理胸内最严重、最致命伤为原则。

Objective To summarize diagnostic methods and surgical management experience of penetrating chest trauma . Methods The clinical data of 603 patients in our department during the past 10 years were analyzed retrospectively in respects of features of injury ,diagnostic methods ,surgical management and outcome ,etc .Results Location of the wounds ：the wounds on the left anterior chest wall had 151 cases ,on the left posterior chest wall 134 cases ,on the right anterior chest 137 cases ,on the right posterior chest 108 cases ,on the bilateral chest 22 cases ,on the root of the neck 35 cases ,on the upper abdome 16 cases .In 453 ca‐ses examined by CT ,96 .03% of these cases were found to be abnormal .In 252 cases examined by X ray ,71 .03% of these cases were found to be abnormal .166 underwent thoracotomy ,26 underwent VATS（Video assisted Thoracoscopic Surgery ） .411 under‐went non operative management .583 were cured ,76 cases developed complications .20 were died .Conclusion Multi spiral CT is a rapidly and accurate diagnostic method to penetrating chest trauma .Incision of thoracotomy is employed according to the lethal damage and the most serious injury organ .