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Management of multiple trauma with mainly thoracic and abdominal injuries： a report of 1166 cases

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Chinese Journal of Traumatology 2009年第2期12卷 118-121页

作者：杨俊高劲谋胡平李昌华赵山宏林曦 Department of Traumatology Emergency Medical Center of Chongqing Chongqing 400014 China

Objective： To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries. Methods： A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries. Results： Of 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% （119/804） and 83.5% （710/850） respectively （ x^2=780.683, P 〈0.01）. The operation rates of blunt and penetrating thoracic injuries was 6.8% （42/617） and 40.6% （76/187） respectively （ x^2=131.701, P〈0.01）. The operation rates of blunt and penetrating abdominal injuries were 77.1% （434/563） and 96.1% （276/287） respectively （ x^2=50.302, P〈0.01）. The operation rates of blunt thoracio-abdominal injuries were 6.8% （42/617） in thoracic region and 77.1% （434/563） in abdomen respectively （x^2=544.043, P〈0.01 ）. Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% （39/41）. Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% （62/854） and 2.9% （9/312）（ x^2=6.51, P〈0.005）. The deaths were mainly due to large volume of blood loss. Conclusions： When both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

关键词： Multiple trauma thoracic injuries Abdominal injuries Hemostasis Surgical procedures, operative

Damage control surgery for severe thoracic and abdominal injuries

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Chinese Journal of Traumatology 2007年第5期10卷 279-283页

作者：黄显凯朱渝军张连阳 Deptartment of Trauma Surgery Research Institute of SurgeryDaping HospitalThird Military Medical University

Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal ***: A retrospective study was done on 37 patients with severe thoracic and abdominal injuries who underwent damage control surgery from January 2000 to October 2006 in our department. There were 8 cases of polytrauma ( with thoracic injury most commonly seen), 21 of polytrauma (with abdominal injury most commonly seen) and 8 of single abdominal trauma. Main organ damage included smashed hepatic injuries in 17 cases,posterior hepatic veins injuries in 8, pancreaticoduodenal injuries in 7, epidural or subdural hemorrhage in 4,contusion and laceration of brain in 5, severe lung and bronchus injuries in 4, pelvis and one smashed lower limb wound in 3 and pelvic fractures and retroperitoneal hemorrhage in 6. Injury severity score (ISS) was 28-45 scores (38.4 scores on average), abbreviated injury scale (ALS) ≥ 4.13. The patients underwent arteriography and arterial embolization including arteria hepatica embolization in 4 patients, arteria renalis embolization in 2 and pelvic arteria retroperitoneal embolization in 7. Once abbreviated operation finished, the patients were sent to ICU for resuscitation. Twenty-four cases underwent definitive operation within 48 hours after initial operation, 5 underwent definitive operation within 72 hours after initial operation, 2 cases underwent definitive operation postponed to 96 hours after initial operation for secondary operation to control bleeding because of abdominal cavity *** cases underwent urgent laparotomy and decompression because of abdominal compartment syndrome and 2 cases underwent secondary operation because of intestinal fistulae (1 case of small intestinal fistula and 1 colon fistula) and gangrene of ***: A total of 28 patients survived, with a survival rate of 75.68%, and 9 died (4 died within 24 hours and 5 died 3-9 days after injury). The trauma d

关键词： thoracic injuries Abdominal injuries Surgery Damage control

Outcomes of surgical management of tracheobronchial injuries a case series from a developing country

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Chinese Journal of Traumatology 2011年第3期14卷 161-164页

作者： Saulat H. Fatimi Hashim M. Hanif Ameera Ahmed Ghina Shamsi Marium Muzaffar Department of Surgery Division of Cardiothoracic Surgery Aga Khan University Karachi Pakistan Medical College Aga Khan University Karachi Pakistan

Objective： Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma. Methods： A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries. Results： The average age was 3 l years with most of the patients being male （14：1）. Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma （blunt and penetrating trauma）. Eightpatients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% （1 patient）. Most patients survived with no sequelae （10 patients） while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management. Conclusions： Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.

关键词： Bronchi Trachea thoracic injuries

Surgical treatment of posttraumatic foreign bodies in the heart or great vessels

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Chinese Medical Journal 2006年第23期119卷 2018-2020页

作者： JIANG Chun-li GU Tian-xiang WANG Chun Department of Cardiac Surgery First Hospital of China MedicalUniversity Shenyang 110001 China

Posttraumatic foreign bodies in the heart or great vessels is rare, which may cause cardiac tamponade, bleeding, shock, infection, embolism, arrhythmia, valve dysfunction, etc.13 The foreign bodies can be removed by surgery or percutaneous intervention.4 In this report we reviewed our experience in managing posttraumatic foreign bodies in 13 patients at our institution from 1992 to 2002.

关键词： thoracic injuries heart injuries foreign bodies blood vessels vascular surgical procedures

Characteristics and outcome of traumatic chest injury patients visited a specialized hospital in Addis Ababa, Ethiopia: A one-year retrospective study

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Chinese Journal of Traumatology 2020年第3期23卷 139-144页

作者： Ararso Baru Ermiyas Weldegiorgis Tigist Zewdu Heyria Hussien College of Medicine and Health Sciences Arbaminch UniversityArbaminchEthiopia College of Health Sciences Addis Ababa UniversityAddis AbabaEthiopia Department of Emergency Medicine School of MedicineCollege of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia

Purpose: Injury continues to be an important cause of morbidity and mortality in both developed and developing countries. Globally, it is responsible for approximately 5.8 million deaths per year and 91% of these deaths occur in developing countries. Road traffic collision, suicides and homicides are the leading cause of traumatic deaths. Despite the fact that traumatic chest injury is being responsible for 10% of all trauma-related hospital admissions and 25% of trauma-related deaths across the world including in Ethiopia, only few published studies showed the burden of traumatic chest injury in Ethiopia. So, this study aims at assessing the characteristics and outcome of traumatic chest injury patients visited Tikur Anbesa Specialized Hospital (TASH) over one year ***: A single center based retrospective study was done. We collected data from patients’ records to assess characteristics and outcome of traumatic chest injury at TASH over one year period. All patients diagnosed with traumatic chest injury and received treatment at the hospital from January 1 to December 31, 2016 regardless of its types and severity levels were included in the study. Patients with incomplete medical records for at least 20% of the study variables and without detailed medical history, or patients died before receiving any health care were excluded from the study. The collected data were cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21.0 for analysis. Bivariate and multivariate logistic regression models were used to examine factors associated with outcome of trau- matic chest injury ***: A total of 192 chest injury patients were included in the study and about one-fourth of chest injury victims were died during treatment period in TASH. Road traffic collision (RTC) was the leading cause of morbidity and mortality among traumatic chest injury victims. Age of the victims (adjusted odds ratio (AOR) 8.9, 95% confidence interval (CI) 1.51-

关键词： thoracic injuries Traffic accidents Ethiopia

Unusual management of thoracoabdominal impalement injury to the right hemiliver and diaphragm

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Chinese Journal of Traumatology 2014年第1期17卷 41-43页

作者： Raimundas Lunevicius Adrian O'Sullivan Cheshire and Merseyside Major Trauma Centre Aintree University Hospital NHS Foundation Trust Lower Lane Liverpool L9 7AL United Kingdom King's Major Trauma Centre King's College Hospital NHS Foundation Trust King's Health Partners Denmark Hill London SE5 9RS United Kingdom

Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal im- palement injury associated with major liver and diaphrag- matic injuries. We successfully treated the impalement in- jury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a col- lection of fluid in the abdominal cavity. The conservativemanagement plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a pa- tient with less invasive techniques yielded a good outcome. This management option may be considered as an alterna- tive for open surgery for hemodynamically stable patients in experienced centres.

关键词： thoracic injuries Abdominal injuries Wounds, penetrating

Use of bronchofiberscopy in management of severe thoracic trauma

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Chinese Journal of Traumatology 2013年第4期16卷 195-198页

作者： LIU Chao-pu GAO Jin-mou HU Ping LI Chang-hua HE Ping WANG Xiao-li XIAO Xia ZHAO Xing-ji Department of Traumatology Chongqing EmergencyMedical Center Chongqing 400014 China Department of Cardiothoracic Surgery ChongqingEmergency Medical Center Chongqing 400014 China

Objective： To investigate the diagnos- tic and therapeutic effect ofbronchofiberscopy in the manage- ment of severe thoracic trauma. Methods： A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal inci- sion （282）, nasal cavity （149） and oral cavity （57）. Intensive SaO2 monitoring as well as blood gas analysis were per- formed pre-, intra- and postoperatively. Simultaneously oxy- gen therapy or ventilatory support was given. Sputum cul- ture was done intraoperatively. Results： Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was posi- tive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery （both P〈0.05）. Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death. Conclusion： Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and spu- tum crust in the airway, manage obstructive atelectasis and pneumonia, and signifcantly improve respiratory fimction and treatment outcome.

关键词： thoracic injuries Bronchoscopy Bronchoalveolar lavage Therapeutics

Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

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Chinese Journal of Traumatology 2013年第6期16卷 351-354页

作者： Mojtaba Chardoli Toktam Hasan-Ghafiaee, Hesam Akbari Vafa Rahimi-Movaghat Emergency Medicine Sina Hospital Tehran Universityof Medical Sciences Tehran 11365-3876 Iran Sina Hospital Tehran University of Medical SciencesTehran 11365-3876 Iran Sina Trauma and Surgery Research Center SinaHospital Students Scientific Research Center TehranUniversity of Medical Sciences Tehran 11365-3876 Iran Sina Trauma and Surgery Research Center SinaHospital Tehran University of Medical Sciences Tehran11365-38761ran

Objective：thoracic injuries are responsible for 25% of deaths of blunt *** X-ray （CXR） is the first diagnostic method in patients with blunt *** aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy （CT） in hemodynamically stable patients with blunt chest ***：Study was conducted at the emergency department of S ina Hospital from March 2011 to March *** stable patients with at least 16 years of age who had blunt chest trauma were *** patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan ***：Two hundreds patients （84% male and 16% female） were included with a mean age of（37.9±13.7） *** fracture was the most common finding of CXR （12.5%） and CT scan （25.5%）.The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,***,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR ***：Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

关键词： Radiography thoracic injuries Tomography, X-ray computed

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma： a case report

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Chinese Journal of Traumatology 2013年第5期16卷 286-287页

作者： KONG Ling-wen TAN Yuan-kang DU Ding-yuan SU Hong-jie ZHANG Wei-ming ZHAO Xing-ji Department of Cardiothoracic Surgery ChongqingEmergency Medical Center Chongqing Institute of Acci-dent & Emergency Medicine Chongqing 400014 China

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.

关键词： Brachiocephalic trunk Brachiocephalic veins thoracic injuries Wounds, penetrating