Author/Editor		Fludernik, Bogdan; Buhanec, Božidar; Avžner, Jože
Title		Uporaba laparoskopa za odstranitev koagulirane krvi pri hematotoraksu
Translated title		Evacuation of clotted blood in hemothorax using laparoscopic instruments
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 66, št. Suppl 1
Publication year		1997
Volume		str. I-13-5
Language		slo
Abstract		Background. Increasing number of traffic injuries incrases number of patients with thoracic injury. Immediate thoracotomy is almost always needed in open thoracic injuries, while blunt thoracic trauma is treated conservatively, patricularly when it is connected with politrauma, however 2% patients with blunt thoracic trauma needed immediate thoracotomy. Patients with pneumothorax or hemothorax are treated with drainage and therapy is almost always successful but in 2% to 30% the operative therapy must be done because of clotted blood evacuation. Early operation prevents greater blood loss in further operations and evaluations of fibrothorax. With development of minimal invasive surgery, such a procedure could be done endoscopicaly. Conclusions. Last year we decided to operate two patients with hemothorax, where conservative drainage was not successful. Both patients were at risk because of other injuries and sickness. Since we had some experience with laparoscopic procedures, we decided to do the operations with less traumatic thoracoscopy. We used the same instruments we usually use at laparoscopy. Both procedures were completed successfully and pulmonary functions after operations were better.
Summary		Izhodišča. Število bolnikov s poškodbo prsnega koša narašča s številom prometnih nesreč. Medtem ko zahtevajo odprte poškodbe večinoma takojšnjo oskrbo s torakotomijo, smo pri topih poškodbah bolj konservativni, zlasti ker gre pri takšnih bolnikih pogosto za politravmo. Le pri 2% topih poškodb prsnega koša se odločimo za takojšnjo torakotomijo, pri ostalih poškodovancih s pnevmo- in hematotoraksom pa je potrebna torakalna drenaža, ki je večinoma uspešen način zdravljenja. Pri 2% do 30% bolnikov s hemototoraksom zdravljenje zaradi zastajanja krvi ni zadovoljivo. Pri teh bolnikih je potrebno čim prej operativno odstraniti strdke. Tako preprečimo večjo izgubo krvi pri kasnejši operaciji ter razvoj empiema ali fibrotoraksa. Z razvojem minimalne invazivne kirurgije je možno takšen poseg narediti torakoskopsko. Zaključki. V lanskem letu smo se v Bolnišnici Celje odločili za operativno zdravljenje hematotoraksa pri dveh bolnikih, ker konservativno zdravljenje ni bilo uspešno. Pri obeh bolnikih je bilo zaradi dodatnih poškodb oziroma bolezni tveganje visoko. Ker smo imeli že dveletne izkušnje z laparoskopskimi operacijami, smo se odločili, da poseg opravimo čim manj travmatizirajoče. Za torakoskopijo, evakuacijo zaostale koagulirane krvi in primerno namestitev drenov smo uporabili laparoskopske instrumente. Posega sta bila uspešno izvedena in pooperativne rentgenske kontrole so pokazale izboljšanje pljučne funkcije pri obeh bolnikih.
Descriptors		THORACIC INJURIES HEMOTHORAX SURGERY, LAPAROSCOPIC VIDEODISC RECORDING THORACIC RADIOGRAPHY