Diagnosis and surgical treatment of paediatric blunt thoracic trauma

Abstract

Introduction. Blunt thoracic injury is a leading cause of death for children over 1 year. 70-82% of children have multiple thoracic injuries. There are still some unresolved questions in diagnosis and treatment of paediatric blunt chest trauma. Materials and methods. The authors analysed the results of treatment of 176 children with blunt chest trauma on the basis of the medical records. Laboratory, functional, and instrumental methods of examination, statistical data processing were used. Results. The main role in the diagnosis of blunt thoracic trauma belongs to chest X-ray in two projections, computed tomography, endoscopy (bronchoscopy, thoracoscopy and/or videoassisted thoracoscopy) ultrasound. Important is an adequate assessment of blood loss. In the acute period were hospitalized 151 (85.79%) patients and 25 (14.21%) patients hospitalized with late complications. Often observed dominant damage of bronchi (20.68%), lung (22.99%) and diaphragm (8.05%). Misdiagnosis was observed in 32.0% of bronchi rupture and 28.0% lung damage, due to the misuse of endoscopic and X- ray methods. In 64.6% major traumatic injuries were combined with pulmonary contusion. Radical surgery used in 87 (49.43%) children. In treatment reconstructive operations were used mostly. Only in 20.68% were used resection methods of surgical treatment. Good results of treatment were observed in 156 (88.64%) patients, satisfactory - in 18 (10.23%), lethal - in 2 (1.13%). Long-term results (within 1 to 8 years) traced in 119 (67.61%) patients - good in 107 children (89.92%), satisfactory in 12 (10.08%). Conclusions. Wide use of endoscopy can clearly establish the nature and prevalence of lesions, volume of blood loss. In the surgical treatment of injuries of the chest should be used reconstructive methods.