胸部刀刺伤剖胸探查的指征和手术策略

Indications and surgical strategies for exploratory thoracotomy of chest stab wound

目的探讨胸部刀刺伤剖胸探查的指征和手术策略。方法回顾性分析上海交通大学附属第六人民医院胸外科2006年1月至2017年12月经剖胸探查救治的80例胸部刀刺伤患者的临床资料。结果 80例胸部刀刺伤患者中单纯胸部刀刺伤36例,合并腹部损伤16例,合并四肢损伤21例,颈根部损伤7例;平均损伤严重度评分(ISS)16.42分。所有患者行急诊剖胸探查术,治愈76例(95%),死亡4例(5%),死亡原因为心脏破裂、失血性休克、弥散性血管性凝血(DIC)。结论进行性的血气胸、通气障碍、心脏压塞是急诊剖胸探查的重要指征,合理把握手术指征、选择手术路径是救治胸部刀刺伤的关键。

Objective To investigate the indications and surgical strategies for exploratory thoracotomy of chest stab wound.Methods We conducted a retrospective analysis of the clinical data of 80 patients who underwent thoracic exploration treatment for chest stab wounds from January 2006 to December 2017 in Shanghai Sixth People's Hospital.Results The 80 cases included 36 cases of stab wound only to chest,16 combined with abdomen wound,21 with limb wound,and 7 with neck wound.The average ISS score is 16.4.After emergency exploratory thoracotomy,76 was cured(95%)and 4 died(5%).The reason for death was cardiac rupture,uncontrolled hemorrhagic shock,and disseminated intravascular coagulation(DIC).Conclusions Progressive hemopneumothorax,ventilation dysfunction,and cardiac tamponade are all important indications of emergency exploratory thoracotomy.Reasonable reactions to the surgical indications and suitable choice of operation pathway are the keys to cure chest stab wound.