胸腔镜在多发性肋骨骨折致重型胸部外伤诊治中的体会

Experience of Thoracoscope in the Diagnosis and Treatment of Severe Chest Trauma Caused by Multiple Rib Fractures

目的：探讨电视胸腔镜手术在多发性肋骨骨折致重型胸部外伤诊断、治疗中的价值。方法：回顾2010年1月~2015年6月某院44例多发性肋骨骨折致重型胸部外伤患者,随机划分为对照组和研究组,两组均为22例,对照组应用常规发进行治疗,研究组应用电视胸腔镜技术进行探查、诊断,同时进行胸腔内血肿清除、胸腔镜下定位引导行肋骨骨折切开复位内固定术等操作,对比两组患者的治疗效果。结果：对照组患者中4例合并膈肌破裂,肺裂伤7例,肋间血管损伤10例,手术时间（147±21）min;研究组术中探查发现2例合并膈肌破裂,肺裂伤5例,肋间血管损伤8例,手术时间（125±18）min。两组对比数据均存在显著差异（P〈0.05）;研究组患者术后复查胸片显示肺复张良好,胸腔无积液积气,对照组胸腔积液积气患者为1例。结论：多发性肋骨骨折致重型胸部外伤患者应用电视胸腔镜诊治,可使诊断及时,避免胸腔内脏损伤漏诊,患者创伤小,恢复快,疗效满意。

Objective： To investigate the value of video assisted thoracic surgery in the diagnosis and treatment of severe thoracic injury caused by multiple rib fractures. Methods： Data of 44 severe chest trauma patients caused by multiple rib fracture from January 2010 to June 2015 were reviewed, who were divided randomly into the study group and the control group, with 22 cases in each group. The control group was treated with conventional therapy, and the study group were treated with video-assisted thoracoscopic tech- nique and intrapleural hematoma, thoracoscopic positioning guide rib fracture by open reduction and internal fixation operation and the curative effect were compared between the two groups. Results： In the control group, 4 cases of diaphragmatic rupture, 7 cases of pulmonary laceration, 10 cases of intercostal vascular in- jury, the operation time was（147±21）min; in the study group, 2 cases of diaphragmatic rupture, 5 cases of pulmonary laceration. 8 cases of intercostal vascular injury, the operation time was （125±18）min. There were significant differences between the two groups （P〈0.05）. The patients in the study group were treated with chest X-ray and chest X-ray, and the lung was good, and there was no effusion in the pleural effusion. The control group were 1 cases of pleural effusion. Conclusion： Thoracoscope can be helpful in the diagnosis and treatment of severe chest trauma caused by multiple rib fractures with the characteristics of timely diag- nosis, quick recovery and good satisfaction.