闭合性气管支气管损伤15例

摘要

Objective To summarize the experiences of diagnosis and treatment for blunt tracheobronchial injuries ( BTI) . Methods From January 1993 to December 2013, 15 patients were diagnosed with BTI and underwent surgical treatment at our hospital.Mean age of the 15 patients (11 men and 4 women) was 26.4 ±4.5 years.All the patients had a history of trauma, which included crushing injury in 8 cases, deceleration injury in 4, fall injury in 2, and traction-type injury in 1.BTI loca-tion: right main bronchus in eight cases, left main bronchus in four cases, upper trachea in one case, lower trachea with the right main bronchus in one case, and cervico-thoracic trachea with left main bronchus in one case .Thoracic computerized tomo-graphy was performed in 15 patients, which showed pneumothorax, subcutaneous emphysema, pneumomediastinum or falling lung sign of Kumpe.Preoperative fiberoptic bronchoscopy examination was performed in 15 cases, which included bronchial atresia in 9 cases, bronchial transection in 3 cases, laceration of trachea in 2 cases, and tracheal transection in 1 case.An e-lective surgical procedure after BTI was performed in 10 cases, and emergency surgery was performed in 5 cases.Tracheo-bron-chial laceration repair were performed in 2 cases, tracheal end-to-end reanastomosis in 1 case, and bronchial end-to-end re-anastomosis in 12 cases.Results There was no operative death, and one case was complicated with anastomotic stenosis.The average operation time was 205.7 ±41.3 minutes, and the average blood loss was 268.4 ±109 ml.The postoperative hospi-tal stay was 11.6 ±3.7 days on average.Follow-up was completed in 15 patients (mean, 29.3 months), and 15 patients were all symptomatic improvement .Conclusion The most common site of BTI was the right main bronchus near Carina parts .Al-though the diagnosis and treatment are often delayed , our findings indicate that chest CT and endoscopic findings could be used for the diagnosis of BTI.Surgical resection and reconstruction are effective methods to repair BTI successfully even many months after they occur.Often they do not require the resection of pulmonary parenchyma .%目的：总结闭合性气管支气管损伤（ Blunt Tracheobronchial Injuries ，BTI）的诊治经验。方法1993年1月至2013年12月，手术治疗闭合性气管支气管损伤15例，男11例，女4例；年龄3～52岁，平均（26.4±4.5）岁。患者均有明确外伤史，其中胸部挤压伤8例，减速伤4例，坠落伤2例，牵拉伤1例；病程7 h至5个月不等。 BTI发病部位：左主支气管4例，右主支气管8例，气管上段1例，气管下段合并右主支气管1例，颈胸段气管合并左主支气管1例。胸部CT检查15例示表现为气胸、皮下气肿、纵隔气肿，或肺坠落征。纤维支气管镜检查15例：支气管闭锁9例，支气管断裂3例，气管裂伤2例，气管断裂1例。外伤后急诊手术5例，择期手术10例；行气管、支气管裂伤修补2例，气管断裂端端吻合1例，支气管断裂端端吻合12例。结果全组患者手术顺利，无术中及术后死亡，1例并发吻合口狭窄。平均手术（205.7±41.3） min，平均失血量为（268.4±109.0） ml，平均术后住院（11.6±3.7）天。随访15例患者平均29.3个月，症状均改善。结论右主支气管靠近隆凸部位是闭合性气管支气管损伤的最常见部位，CT三维重建与支气管镜是BTI诊断的有效方式，BTI常发生诊断延误，手术重建或修补是治疗BTI的有效措施，多数患者可保留断裂支气管远端的肺组织。