Meyer M
Department of Cardiothoracic Surgery, Martin-Luther-University Halle-Wittenberg, Germany.
Thorac Cardiovasc Surg. 2001 Apr;49(2):115-9. doi: 10.1055/s-2001-11704.
Tracheobronchial ruptures are occurrences which mainly result from blunt or penetrating neck or thoracic trauma, but also from long-term complications of intubation or tracheostomy. Acute iatrogenic tracheobronchial lesions are very uncommon.
From February 1995 to July 1998, we treated 13 patients (12 female, 1 male, mean age 68 years, range 45-86) in our institution for iatrogenic tracheobronchial injuries after single lumen intubation (n = 8), double lumen intubation (n = 4), and tracheostomy (n = 1). We retrospectively analyzed the medical records of these patients concerning age, sex, symptoms, endoscopic and intraoperative findings, treatment and outcome.
All patients underwent surgical treatment via right-sided thoracotomy. In the cases of 11 patients, repeated postoperative bronchoscopy revealed sufficient reconstruction of the lesions. Nevertheless, only 5 patients survived. The remainder died of the sequelae of trauma-related hypoxia, underlying (malignant) diseases, or of septic multiorgan failure after a median of 15 days (1 hour to 27 days).
While technical problems of tracheobronchial reconstruction in our series were controllable, the long-term results were not satisfying. Our data suggest that the key for better outcome of these kind of lesions lies in an early diagnosis and immediate treatment, thus keeping the trauma-treatment interval with the concomitant hypoxic damage as short as possible.
气管支气管破裂主要由钝性或穿透性颈部或胸部创伤引起，但也可由插管或气管造口术的长期并发症导致。急性医源性气管支气管损伤非常罕见。
1995年2月至1998年7月，我们机构治疗了13例医源性气管支气管损伤患者（12例女性，1例男性，平均年龄68岁，范围45 - 86岁），这些损伤分别由单腔插管（n = 8）、双腔插管（n = 4）和气管造口术（n = 1）引起。我们回顾性分析了这些患者的病历，内容包括年龄、性别、症状、内镜及术中发现、治疗及结果。
所有患者均通过右侧开胸手术治疗。11例患者术后复查支气管镜显示损伤修复良好。然而，仅5例患者存活。其余患者在创伤相关缺氧、基础（恶性）疾病或感染性多器官功能衰竭的后遗症后死亡，中位生存期为15天（1小时至27天）。
虽然我们系列研究中气管支气管重建的技术问题是可控的，但长期结果并不理想。我们的数据表明，改善这类损伤预后的关键在于早期诊断和立即治疗，从而使创伤治疗间隔与伴随的缺氧损伤尽可能短。
