Clinical features and management of combined thoracoabdominal injury / 中国普通外科杂志

ABSTRACT

Objective To review the clinical features and early management of combined thorcoabdominal injury(CTI),to decrease the mortality rate.Methods A retrospective study was carried out in 63 cases of CTI treated surgically from May 1990 to May 2007.There were 34 cases with blunt injuries and 29 cases with penetrating injuries.Forty-seven patients had rapture of left diaphragm,9 cases had rupthure of right diaphragm,7 cases had rupture of both diaphragms,24 cases were combined with traumatic diaphragmatic hernia,63 cases were combined with hemopneumothorax,and 60 cases were combined with shock.Forty-one cases were diagnosed correctly before surgery.Sixty-three cases were treated by surgery,among them,surgery was performed through left thoracotomy in 18 cases,through a right thoracotomy in 2 cases,through bilateral thoracotomy in 5 cases,through thoraco-abdominal incision in 2 cases,and through the abdominal route in 32 cases.Results Fifty-six cases were cured,and 7 cases(11.1 %) died.The main cause of death was hemorrhagic shock.Conclusions CTI has high mortality rate,and the most frequent cause of mortality is hemorrhagic shock.The operative approach is based on the individual injury condition.Early diagnosis and timely surgical intervention is the key to improving the cure rate and reducing mortality in severe CTI.