Penetrantna povreda vrata sa posledičnim grudno-hirurškim komplikacijama rešenim primenom video-asistirane torakoskopije

  • Nataša Vešović Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Aleksandar Ristanović Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Vlado Cvijanović Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Dejan Stojković Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Nebojša Marić Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Vanja Kostovski Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Ljubinko Djenić Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
  • Aleksandar Nikolić Military Medical Academy, Clinic for Chest Surgery, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP170904053V
Ključne reči: vrat, povrede, hematotoraks, pneumotoraks, drenaža, torakoskopija, hirurgija, minimalno invazivne procedure

Sažetak


Uvod. Penetrantne povrede vrata su vrlo ozbiljne povrede zbog mogućih lezija grkljana, dušnika, jednjaka i velikih krvnih sudova te regije. Prikaz bolesnika. Bolesnik, star 28 godina povređen je ubodom razbijenog stakla u predeo prednje strane baze vrata. Bolesnik se javio na pregled zbog otežanog disanja, a povreda je nastala noć uoči prijema. Prilikom pregleda otorinolaringologa konstatovana je ubodna rana u predelu baze leve strane vrata dužine oko 2 cm bez znakova aktivnog krvarenja i prisustva povreda dubljih anatomskih struktura vrata. Klinički i radiološki ova povreda manifestovala se levostranim hematopneumotoraksom. Nakon prijema u jedinicu intenzivne nege učinjena je torakalna drenaža, kojom je evakuisano inicijalno 400 mL hemoragičnog sadržaja. Nakon 24 časa došlo je do hemodinamske nestabilnosti bolesnika. To je bila indikacija za hiruršku intervenciju. Primenjena je video-asistirana torakoskopija (VATS) kojom je dijagnostikovana priroda povrede. Intraoperativno je uočena presečena pleuro-pulmonalna priraslica koja se nalazila u vrhu intratorakalnog prostora odakle je kontinuirano krvarilo. Urađena je hirurška hemostaza. Tokom daljeg lečenja, koje je ukupno trajalo tri nedelje, morali smo zbog prolongirane aerostaze da plasiramo još jedan torakalni dren lateralnije i za jedan interkostalni prostor više od prethodnog. Nakon postignute kompletne reekspanzije levog pluća drenovi su izvađeni i bolesnik je otpušten iz klinike. Zaključak. VATS danas zauzima sve više mesta u definitivnom zbrinjavanju torakalne traume. Ovom minimalno invazivnom metodom u mogućnosti smo da lokalizujemo i utvrdimo vrstu povrede, zbrinemo iste i dalje pratimo evaluaciju patoloških promena pluća, perikarda, medijastinuma, pleure i zida grudnog koša. Kod ubodnih rana vrata moramo misliti i isključiti i povrede pluća i pleuralnih prostora.

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Objavljeno
2021/08/04
Broj časopisa
Vol. 77 Br. 3 (2020): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika