ABSTRACT
Thoracic and abdominal injuries caused air weapons are rarer compared with gunshot wounds. Nevertheless, pneumatic weapons are able to inflict potentially fatal lesions despite small mass and dimension of projectile. Three clinical cases of patients with various internal injuries are presented in the article. Differentiated diagnostic and surgical approach is suggested.
Subject(s)
Abdominal Injuries/etiology , Firearms , Thoracic Injuries/etiology , Wounds, Gunshot/etiology , Abdominal Injuries/diagnosis , Abdominal Injuries/therapy , Firearms/classification , Humans , Thoracic Injuries/diagnosis , Thoracic Injuries/therapy , Wounds, Gunshot/diagnosis , Wounds, Gunshot/therapyABSTRACT
AIM: To assess the outcomes of video-assisted techniques compared with conventional procedures. MATERIAL AND METHODS: 596 victims with thoracic injuries were enrolled. Video-assisted techniques were applied in 236 cases, conventional procedures - 360 patients. Groups were standardized by the type of surgery. Morbidity, hospital-stay and mortality according to Clavien-Dindo classification have been analyzed. RESULTS: There was similar incidence of complications in both groups. However, severe adverse events followed by redo surgery under general anesthesia occurred in 1.2% and 7.1% of cases respectively (p<0.05). Hospital-stay was 11.3±3.6 and 14.5±5.3 days respectively (p<0.05). Mortality was 0.58% vs. 1.08% respectively (p>0.05). CONCLUSION: In victims with thoracic injuries and no need for urgent thoracotomy video-assisted techniques are preferable for diagnosis and treatment.
Subject(s)
Postoperative Complications , Thoracic Injuries , Thoracic Surgery, Video-Assisted , Adult , Female , Humans , Length of Stay , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pneumonectomy/adverse effects , Pneumonectomy/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/surgery , Reoperation/methods , Reoperation/statistics & numerical data , Russia , Survival Analysis , Thoracic Injuries/diagnosis , Thoracic Injuries/mortality , Thoracic Injuries/surgery , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/instrumentation , Thoracic Surgery, Video-Assisted/methods , Thoracotomy/adverse effects , Thoracotomy/methodsABSTRACT
AIM: to improve treatment of patients with spontaneous pneumothorax who had not postoperative pulmonary impermeability. MATERIAL AND METHODS: 87 patients with spontaneous pneumothorax underwent videothoracoscopy (VTS), lung resection supplemented by pleurodesis (parietal pleurectomy or pleural abrasion). Absence of pulmonary impermeability was observed in 5 (5.7%) patients. RESULTS AND DISCUSSION: Re-operation was performed in 2 patients (Vanderschuren 2 and 3) namely re-thoracoscopy and thoracotomy with additional ligation of air origins. Drainage tubes were removed in 4 and 17 days postoperatively in patient without/with emphysema respectively. In patient (Vanderschuren 1) who underwent thoracoscopic resection and parietal pleural abrasion valve bronchoblocation was performed in 9 days after VTS due to persistent pneumothorax. Pleural drainage tube was removed in 13 days (emphysema) after bronchial valve deployment. 2 patients (Vanderschuren 4) had heterogeneous pulmonary emphysema. One of them underwent video-assisted mini-thoracotomy, lung resection with reinforcement of seams with synthetic material. In other observation conversion to thoracotomy followed by atypical resection of bullous emphysema and manual suturing of lung was applied. In both cases bronchoblocation was performed intraoperatively with good results. Drainage tubes were removed in 13 and 17 days respectively. There were no complications. CONCLUSION: Intraoperative endoscopic bronchoblocation is advisable if air leakage is considerable in operating theater and complicates lung smoothing. Such approach reduces hospital-stay and improves outcomes.
