The Clinical Research About Minimally Invasive Treatments Of Traumatic Hemothorax

Objective:To analyze the risk factors associated with the complications of different approaches for the treatment of traumatic hemothorax and to compare the clinical effects of video-assisted thoracoscopic surgery(VATS)and thoracotomy in the treatment of traumatic hemothorax.The aim of the study was to provide references for making better clinical decision-making of minimally invasive treatments of traumatic hemothorax.Methods:A retrospective study was conducted to analyze the clinical data of who admitted to the thoracic surgery department of tangdu hospital of the air force military medical university from January 1,2012 to December 31,2018.In the first three parts of the study,the patients with traumatic hemothorax treated by observation,closed thoracic drainage and VATS were selected.The risk factors associated with the complications were analyzed by multivariate logistic regression.The clinical data were compared between VATS and thoracotomy by 1:1 propensity score matching(60 pairs).Results:(1)A total of 54 cases with traumatic hemothorax treated by observation were included.32(59.26%)of them failed to observe.Multivariate logistic regression analysis showed that the number of rib fractures≥3(OR=5.535,95%CI 1.065～28.754,P=0.042)and pneumothorax(OR=9.529,95%CI 1.988 ～ 45.580,P=0.005)were significantly correlated with the failure of traumatic hemothorax with observational treatment.(2)A total of 102 patients with traumatic hemothorax treated by closed thoracic drainage were included.27(26.47%)patients of them had complications.Multivariate logistic regression analysis showed that the number of rib fractures > 5(OR=2.884,95%CI 1.039 ～ 8.000,P=0.042)was significantly correlated with the complications of traumatic hemothorax treated by closed thoracic drainage.(3)A total of 94 patients with traumatic hemothorax treated by VATS were included.12(12.77%)patients of them had complications.Multivariate logistic regression analysis showed that the time from injury to surgery>3d(OR=7.972,95% CI 1.481～42.907,P=0.016)and pulmonary air leakage during the operation(OR=5.865,95% CI 1.060～32.441,P=0.043)were significantly correlated with the complications of traumatic hemothorax treated by VATS.(4)After 1:1 propensity score matching,there was no significant difference between the VATS group and thoracotomy group in the rate of complications and hospital length of stay(LOS).Patients with VATS had less duration of operative,postoperative hospital LOS,duration of drainage,intensive care unit LOS and smaller postoperative volume of drainage than thoracotomy.Conclusion:The clinical decision-making of traumatic hemothorax should made thoracic injury such as rib fracture,pneumothorax and post-injury time together as consideration.The number of rib fractures≥3 and pneumothorax are the independent risk factors of failed observational treatment.The number of rib fractures>5 is a risk factor for complications of closed thoracic drainage in the treatment of traumatic hemothorax.The time from injury to surgery > 3d and pulmonary air leakage during the operation are independent risk factors for complications of VATS in the treatment of traumatic hemothorax.For traumatic hemothorax with stable hemodynamics,VATS is safe and effective instead of thoracotomy,which can accelerate postoperative recovery and shorten the hospital LOS.