الفهرس 
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Abstract
Chest trauma is account for 10% to 15% of all traumas and is the cause of death in 25% of all fatalities resulting from trauma. Over 70% of thoracic injuries result from blunt trauma, most of which are caused by automobile accidents, whereas penetrating trauma may result from stab wounds, gunshots and shrapnel injuries.
The majority of patients with thoracic trauma can be managed non-operatively, with or without tube thoracostomy, however, there is a small, but significant (10-15%), subgroup of thoracic trauma victims who require thoracotomy.
Thoracotomy allows direct visualization for all intra-thoracic structures and so any injury can be managed quickly and adequately, that it will be required in 30% of cases presenting after penetrating chest injury and in 15% after blunt chest trauma.
This work was carried out to study the cases of chest trauma that required thoracotomy as regards the number of patients, type of trauma and inflicting agent, types and indications of thoracotomy, outcome results and complications before and after Egyptian revolution(25th January 2011).
This study included 46 patients presented to Emergency unit and Cardiothoracic department in Alexandria university hospitals with chest trauma and underwent thoracotomy, all patients included in the study were randomly allocated into two groups:
• Group I:
Patients admitted 6 months before Egyptian revolution (25th January 2011). It included 12 patients.
• Group II:
Patients admitted 6 months after Egyptian revolution (25th January 2011). It included 34 patients.
In group I (n= 12); Patients were 91.7% males (n=11) and 8.3% females (n=1), while in group II (n= 34); Patients were 94.1% males (n=32) and 5.9% females (n=2). In group I the age ranged from 12.0-42.0 with a mean ± SD of 28.0 ± 8.57 and median value of 27.50, while in group II the age ranged from 7.0-60.0 with a mean ± SD of 28.24 ± 11.80 and median value of 27.0.
In group I; blunt trauma was found in 25% of patients (n=3) which were 16.7% RTA and 8.3% FFH, penetrating trauma was found in 75% of patients (n=9) and all were due to stab chest and no iatrogenic trauma cases was found. In group II; blunt trauma was found in 17.6% of patients (n=6) which were 11.8% RTA and 5.9% FFH, penetrating trauma was found in 76.5% of patients (n=26) which were 44.1% stab chest and 32.4% gun-shot, and iatrogenic trauma cases was found in 5.9% of patients (n=2). There was statistically significant difference among the two groups in penetrating trauma as regards stab chest and gun-shot (FEp= 0.033).
Statistical analysis showed significant relationship between type of trauma and resultant pathology in patients underwent thoracotomy in both groups as most common pathology was massive haemothorax in penetrating trauma followed by lung injuries, followed by diaphragmatic injury, followed by cardiac tamponade, followed by clotted haemothorax, followed by pulmonary vessels injury, then encysted empyema, while in blunt trauma the most common was clotted haemothorax, followed by tracheobronchial injury, then diaphragmatic injury.
The most common pathology in iatrogenic trauma was massive haemothorax due to pulmonary vessels injury during bronchoscopic extraction of FB in a case and thoracoscopic sympathectomy in another case.
In group I; there were 2 patients (16.7%) with right thoracotomy, 10 patients (83.3%) with left thoracotomy, and no cases with bilateral thoracotomy. In group II; there were 12 patients (35.3%) with right thoracotomy, 21 patients (61.8%) with left thoracotomy and 1patient (2.9%) with bilateral thoracotomy. there was no statistically significant difference between the two studied groups (MCp = 0.471).
In group I; there were no cases of resuscitative thoracotomy, 9 patients (75%) of emergency thoracotomy which included 6 patients with anterior thoracotomy (50.0%), 3 patients with posterolateral thoracotomy (25%), there were no cases of clamshell incision or combined sternotomy and thoracotomy incision. There were also 3 patients of elective thoracotomy (25%) which were posterolateral.
In group II; there were 2 cases of resuscitative thoracotomy (5.9%), 23 cases of emergency thoracotomy (67.6%) which included 16 patients with anterior thoracotomy (47.1%), 5 patients with posterolateral thoracotomy (14.7%), 1 patient with clamshell incision (2.9%) and 1 patient with combined sternotomy and anterior thoracotomy (2.9%).There were also 9 cases of elective thoracotomy (26.5%), all of them were via posterolateral approach. There was no statistically significant difference between the two studied groups (MCp = 1.000 and 0.827).
We found a significant relationship between type of thoracotomy and pathology as most common indications for resuscitative thoracotomy in group II were haemodynamic instability and cardiac arrest, massive haemothorax due to pulmonary vessels injury, in emergency thoracotomy; in group I were massive haemothorax, lung injuries, diaphragmatic injuries, cardiac tamponade and haemodynamic instability, while in group II were massive haemothorax, lung injuries, haemodynamic instability, cardiac tamponade, pulmonary vessels injury, diaphragmatic injuries and tracheobronchial injuries, and in elective thoracotomy; in group I was clotted haemothorax, while in group II were neglected diaphragmatic injuries, clotted haemothorax, encysted empyema and neglected tracheobronchial injury.
Diaphragmatic injuries was encountered in group I patients with a percent 33.3% (n=4), compared to group II where 23.5% (n=8) of cases, showing no statistical significance (FEp = 0.703). As regard the side of diaphragmatic injuries, in group I; there were 8.3% (n=1) on the right side and 25.0% (n=3) on the left side, while in group II; there were 5.9% (n=2) on the right side and 17.6% (n=6) on the left side, with no statistical significance (FEp = 1.000).
Lung injuries was encountered in group I patients with a percent 33.3% (n=4), compared to group II where 38.2% (n=13) of cases, showing no statistical significance (FEp = 1.000). As regard the side of lung injuries, in group I; there were 16.7% (n=2) on the right side and 16.7% (n=2) on the left side, while in group II; there were 20.6% (n=7) on the right side and 17.6% (n=6) on the left side, with no statistical significance (FEp = 1.000).
Tracheobronchial injuries was not encountered in group I patients, compared to group II where 8.8% (n=3) of cases, showing no statistical significance (FEp = 0.557). As regard the side of tracheobronchial injuries, in group II; all cases were on the right side.
Pulmonary vessel injuries was not encountered in group I patients compared to group II where 11.8% (n=4) of cases, showing no statistical significance (FEp = 0.560). As regard the side of pulmonary vessel injuries in group II; there were 2.9% (n=1) on the right side and 5.9% (n=2) on the left side.
Clotted haemothorax was encountered in group I patients with a percent 33.3% (n=4), compared to group II where 8.8% (n=3) of cases, showing no statistical significance (FEp = 0.064).
Encysted empyema was not encountered in group I patients, compared to group II where 5.9% (n=2) of cases, showing no statistical significance (FEp = 1.000).
As regard type of operations;
Lobectomy was not encountered in group I while in group II was encountered in 8.8% (n=3) with no statistical significance (FEp = 0.557).
Wedge resection was not encountered in group I while in group II was encountered in 8.8% (n=3) with no statistical significance (FEp = 0.557).
Pneumonectomy was not encountered in group I while in group II was encountered in 5.9% (n=2) with no statistical significance (FEp = 1.000).
Repair of diaphragmatic injuries was encountered in group I in 33.3% (n=4) while in group II was encountered in 20.6% (n=7) with no statistical significance (FEp = 0.441).
Repair of cardiac injuries was encountered in group I in 25.0% (n=3) while in group II was encountered in 17.6% (n=6) with no statistical significance (FEp = 0.678).
CABG (on-pump) was not encountered in group I while in group II was encountered in 2.9% (n=1) with no statistical significance (FEp = 1.000).
Repair of Tracheobronchial injuries was not encountered in group I while in group II was encountered in 2.9% (n=1) with no statistical significance (FEp = 1.000).
Repair of lung injuries was encountered in group I in 25.0% (n=3) while in group II was encountered in 23.5% (n=8) with no statistical significance (FEp = 1.000).
Decortication was encountered in group I in 25.0% (n=3) while in group II was encountered in 14.7% (n=5) with no statistical significance (FEp = 0.412).
Open cardiac massage was not encountered in group I while in group II was encountered in 5.8% (n=2) with no statistical significance (FEp = 1.000).
The outcome of patients in group I was; smooth outcome was in 83.3% (n=10) of patients, morbidity and complications were in 16.7% (n=2) of patients and there were no mortality cases, compared to group II; smooth outcome was in 58.8% (n=20) of patients, mortality was in 17.6% (n=6) of patients and morbidity and complications were in 23.5 (n=8).