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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(06): 436-445
DOI: 10.1055/s-0042-118058
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CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Der Patient mit Thoraxtrauma: chirurgische Versorgung

The Patient with Chest Trauma: Surgical Management
Patrick Zardo
,
Henning Busk
,
Stefan Piatek
,
Norman Zinne
,
Irina Kropivnitskaya
,
Ingo Kutschka
Further Information

Publication History

Publication Date:
14 June 2017 (online)

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Zusammenfassung

Bei Thoraxtraumata reicht das Spektrum von Verletzungen des Herzens und der großen Gefäße über Parenchymläsionen mit Pneumothorax, Blutungen aus den Interkostalgefäßen, bis hin zu chronischen Hämatothoraces und sekundären Empyemen. Die Anlage einer Thoraxdrainage stellt oft eine suffiziente Therapie dar, in bestimmten Fällen ist aber eine weitergehende chirurgische Therapie in minimalinvasiver Technik (VATS) oder via Thorakotomie erforderlich.

Abstract

Even though isolated cases of penetrating chest wounds are exceptionally rare in Germany, chest trauma accounts for major morbidity and mortality in over 18 0000 multitrauma patients encountered every year. Injuries range from immediately fatal cardiac wounds and major vessel lacerations to intercostal bleeding, parenchymal damage, chronic haematothorax and secondary empyema. Placement of large-bore chest tubes constitutes a sufficient treatment for most of these pathologies. In select cases further treatment either by minimally invasive techniques (VATS) or conventional thoracotomy is warranted.

Kernaussagen

  • Penetrierende Thoraxverletzungen in Deutschland sind ausgesprochen selten.

  • Stumpfe Thoraxtraumata werden häufig im Rahmen von Polytraumata beobachtet und können prognosebestimmend sein.

  • Das Spektrum reicht von unmittelbar fatalen Verletzungen des Herzens und der großen Gefäße über Parenchymläsionen mit Pneumothorax, Blutungen aus den Interkostalgefäßen, bis hin zu chronischen Hämatothoraces und sekundären Empyemen.

  • Die Drainageanlage stellt noch immer die wichtigste therapeutische Maßnahme für die Mehrzahl der Patienten dar.

  • Bei korrekter Durchführung ist die Drainageanlage ein sicheres Verfahren.

  • Weitergehende chirurgische Maßnahmen können inzwischen häufig in minimalinvasiver Technik durchgeführt werden.

  • Thorakale Verletzungen können auch im weiteren Verlauf zu Komplikationen wie Hämatomverhalt und Empyem führen, die sekundär chirurgisch behandelt werden müssen.

Schlüsselwörter

penetrierendes Thoraxtrauma - stumpfes Thoraxtrauma - Thoraxdrainage - Thorakotomie - VATS

Key words

penetrating chest wound - blunt chest trauma - chest tube - thoracotomy - VATS
 

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