LA VIDEO TORACOSCOPIA EN EL MANEJO DEL TRAUMA TORÁCICO

Abstract

RESUMEN: La toracostomía permanece siendo el tratamiento de elección en el trauma torácico. El hemotórax coagulado o el sangramiento continuo junto a la sospecha de laceración diafragmática requieren a menudo la realización de la toracotomía convencional. La finalidad de esta investigación es describir la experiencia lograda entre julio 1993 de y octubre de 2006, en 144 pacientes que fueron sometidos a cirugía video torácica por traumatismo torácico penetrante, el 93,8% - contuso 6,2%. Las indicaciones fueron: hemotórax coagulado, sospecha de laceración diafragmática-sangramiento > de 150 cc por hora. En el 93,8% se confi rmó el diagnóstico de trauma penetrante. El hemotórax coagulado se evacuó exitosamente. Las laceraciones diafragmáticas; fueron satifactoriamente reparadas. En los sangramiento continuos se demostró el origen arterial y en el parénquima pulmonar lacerado; ABSTRACT: Thoracostomy remains the treatment of choice for thoracic injuries. Although this approach is adequate for most injuries, a clotted hemothorax or continued hemorrhage after chest tube placement can present the surgeon with no treatment option other than a thoracotomy. We describe the experience gained with 144 patients with thoracic injuries who underwent Standard Videothoracoscopy operations between January 1993 and October 2006. Patients with penetrating; 93.8%, and blunt; 6.2% injuries, were examined thoracoscopically and were found to suffer clotting of the hemothorax, suspected diaphragmatic injury, and continuous bleeding. Clotted hemothorax was successfully evacuated. Diaphragmatic laceration was suspected due to abnormal chest radiographs and the proximity of penetrating wounds, and was confi rmed thoracoscopically. Lacerations were successfully repaired with thoracoscopy techniques. A total of 66 patients underwent thoracoscopy for continued hemorrhaging (greater than 150 cc per hour) after tube thoracostomy. Intercostal artery and lung injuries were confirmed for all patients; however, diathermy and clips provided haemostasis without a thoracotomy. Videothoracoscopy is a precise, safe, and minimally invasive method for the assessment of diaphragmatic injuries, the control of continued chest bleeding, and the early evacuation of clotted hemothorax. This technique should be used more frequently in patients with thoracic traumas. Technical advances may expand the therapeutic role of thoracoscopy.