摘要：
Objective To summarize the experiences of diagnosis and treatment for chest penetrating injury with foreign body retention and to make further improvement of the outcomes.Methods A retrospective analysis was made on clinical data of 28 patients with chest penetrating injury with foreign body rentention in Chongqing E-mergency Medical Center from Jan.1997 to May 2015.There were 24 males and 4 females,with age ranged from 15-64 years(average,43.5 years old).Admission time after injury ranged from 20 minutes to 37 hours,with an av-erage of 52.4 minutes.Results All these 28 patients accepted both exploratory thoracotomy and foreign body re-moval operation.The surgical approach choices included 14 patients with anterolateral thoracotomy incision(50%), 7 patients with posterolateral thoracotomy incision(25%),3 patients with the thoracotomy incision by collarbone and the 1st and 2nd rib cutting-off(10.72%),2 patients with sternotomy(7.14%),and 2 patients with thoracoabdomi-nal incision(7.14%).There were 51 cases of viscera damage,including 22 cases of lung laceration(43.14%),5 cases of heart and great vascular injury(9.80%),5 cases of intercostal artery injury(9.80%),8 cases of diaphrag-matic muscle injury(15.69%),4 cases of spine and mediastinum injury(7.84%),1 case of ductus thoracicus inju-ry(1.96%),and 6 cases of abdominal viscera injury(11.77%).All the damaged viscera were performed one -stage definitive operation,such as hemostasis and suture repair after pneumonotomy,heart and great vascular lacera-tion suture repair,intercostals arteries hemostasis,mediastinum hematoma removal,diaphragmatic repair,ductus tho-racicus ligation,liver repair,gastrorrhaphy,and splenectomy.In this group,27 cases achieved perfect foreign body removal(96.43%) and 1 case achieved foreign body retention(3.57%).Two cases died(7.14%).Conclusion Proper preoperative life support,targeted incision approach choice,explicit labor division and reasonable operation are keys to the treatment of chest penetrating injury with foreign body retention.%目的：总结胸部穿透伤伴异物存留的救治经验，进一步提高诊治水平。方法笔者回顾性分析1997年1月～2015年5月收治的胸部穿透伤伴异物存留28例患者的临床资料，其中男性24例，女性4例；年龄15～64岁，平均43．5岁。受伤至入院时间20min ～37h，平均52．4min。结果本组28例患者均急诊行剖胸探查及异物取出术，剖胸手术入路选择前外侧切口14例（50．00％），后外侧切口7例（25．00％），锁骨及第1、2肋切断3例（10．72％），胸骨正中切口2例（7．14％），胸腹联合切口2例（7．14％）；脏器损伤51例次，其中肺裂伤22例次（43．14％），心脏大血管伤5例次（9．80％），肋间动脉伤5例次（9．80％），脊柱及纵隔伤 4例次（7．84％），膈肌伤 8例次（15．69％）， 胸 导 管 1例 次（1．96％），腹腔脏器伤6例次（11．77％）。对损伤脏器均行一期确定性手术，包括肺裂伤切开深部止血后缝合、心脏大血管修补缝合、肋间动脉缝扎止血、纵隔血肿清除、膈肌修补、胸导管结扎以及肝脏、胃修补和脾切除。27例（96．43％）异物完全取出，1例（3．57％）部分异物残留，死亡 2例（7．14％）。结论术前恰当的生命支持、术中针对性选择切口、明确人员分工、合理的手术操作是治疗胸部穿透伤伴异物存留成功的关键。
