Early evacuation of traumatic retained hemothoraces using thoracoscopy: A prospective, randomized trial

被引:108
作者
Meyer, DM
Jessen, ME
Wait, MA
Estrera, AS
机构
[1] Department of Surgery, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX
[2] Division of Thoracic and Cardiovascular Surgery, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX 75235-8879
关键词
D O I
10.1016/S0003-4975(97)00899-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Failure to adequately evacuate blood from the pleural space after trauma may result in extended hospitalization and complications such as empyema. Methods. Patients with retained hemothoraces were prospectively randomized to either a second tube thoracostomy (group 1, n = 24) or video-assisted thoracoscopy (VATS) (group 2, n = 15). Group 1 patients in whom additional tube drainage failed were subsequently randomized to either VATS or thoracotomy. Study end points included duration and costs of hospitalization. Results. During a 4-year period, 39 patients were entered into the study. Patients in group 2 had shorter duration of tube drainage (2.53 +/- 1.36 versus 4.50 +/- 2.83 days, mean +/- standard deviation; p < 0.02), shorter hospital stay after the procedure (3.60 +/- 1.64 versus 7.21 +/- 5.30 days; p < 0.02), and shorter total hospital stay (5.40 +/- 2.16 versus 8.13 +/- 4.62 days; p < 0.02). Hospital costs were also]less in this group ($7,689 a 3,278 versus $13,273 +/- 8,158; p < 0.02), There was no mortality in either group. No group 2 patient required conversion to thoracotomy. In 10 group I patients additional tube placement failed, and this subset was randomized to VATS (n = 5) or thoracotomy (n = 5). No significant difference in clinical outcome was found between these subgroups. Conclusions. In many patients treated only with additional tube drainage (group 1), this therapy fails, necessitating mg further intervention.]intent to treat with early VATS for retained hemothoraces deceases the duration of tube drainage, the length of hospital stay, and hospital cost. Early intervention with VATS may be a more efficient and economical strategy for managing retained hemothoraces after trauma. (C) 1997 by The Society of Thoracic Surgeons.
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收藏
页码:1396 / 1400
页数:5
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