[Treatment of penetrating lung parenchyma injuries]

ABSTRACT

Reports of military injuries have advocated early thoracotomy and aggressive management of pulmonary injuries with resection; which opposed to the more conservative and traditional treatment with chest tube thoracostomy in civilian trauma. This study is done in order to study the result of urban lung injury treatment. A retrospective descriptive study was performed in the General Surgery Department of Imam Reza Hospital during the years 1382 - 1383, to determine the incidence of thoracotomy and lung resection in civilian injuries and to evaluate the effective treatment of these injuries in 1168 patients. Indications of thoracotomy were 1- Air leakage after 2 weeks, 2- drainage of more than 1500 cc blood after tube thoracostomy, 3- Bleeding speed more than 200cc/hour, 4-Massive air leakage with collapsed lung. All patients with mediastinal or heart trauma were excluded from this study. Personal, laboratory and treatment data were recorded in the quastionare. Data was Analyzed using qualitive statistics and frequency distribution tabels. Between 1368-1382 in a series of 1168 patients, there were 384-gunshot wound and 784-stab wound to the thorax. 283 patients with gunshot wound [74%] and 602 with stab wound [77%] were treated with chest tubes alone. 68 patients [9%] of the total required operative thoracotomy. Pulmonary resection was done in 18 patients [9 wedge resection, 6 lobectomy and 3 pneumonectomy]. Mortality rate for all injuries was 2/3%, 0.7% for those treated with chest tube alone, 30% for pulmonaryhilar injuries which led to pneumonectomy, 8.6% for sewed parenchymal injuries and 28% for lung resection. Most civilian lung injuries can be treated by tube thoracostomy alone. Only 15-30% will require thoracotomy, among those most injuries can be handled by simple over - sewing of the lung. Some patients may require pulmonary resection because of sever tissue destruction, in these injuries lobectomy may be performed