胸部外傷手術例の治療成績

Outcomes of Surgical Treatment for Chest Trauma

胸部外傷は日常診療でしばしば遭遇するが，患者背景や受傷機転によって多彩な病態や経過を示す．胸腔内臓器の出血や胸壁損傷は生命維持に直結する緊急度の高い病態をきたしやすく，治療の遅れによって致命的な転機をたどる場合がある．一方で，手術の至適時期や適応，手技については定型化されていない．

Background：Intra-thoracic organ bleeding and chest wall injury following chest trauma can easily lead to life-threatening emergencies and a delay in treatment may lead to fatal outcomes. Interestingly, the optimal timing, indications, and surgical techniques have not been standardized.

Method：We retrospectively analyzed 35 patients who underwent surgical treatment for chest trauma.

Results：All patients with penetrating trauma （n＝4） underwent emergency surgery for a hemothorax. There were no postoperative complications or hospital deaths. All patients with blunt trauma （n＝31） had multiple rib fractures；rib fixation was performed in 29 patients （94％）. Eight patients （26％） had flail chest. The duration from injury to surgery averaged 7.5 days. The prognosis was generally favorable with no postoperative complications, but two patients died in the hospital due to multiple organ failure caused by high-energy trauma. Patients with flail chest or multiple organ injury had prolonged postoperative hospital stays.

Conclusions：Patients who sustain chest trauma follow various clinical courses. Appropriate timing of surgical intervention at an early stage after injury can be life saving and hasten a functional recovery.