Francis Sabina, Gaspard Donald J, Rogers Nancy, Stain Steven C
Huntington Memorial Hospital, Pasadena, California, USA.
J Natl Med Assoc. 2002 Jan;94(1):21-4.
Laryngotracheal trauma is life-threatening. We identified 23 patients between 1992 and 1998 with laryngeal (12), tracheal (8), and combined injuries (3). Nineteen patients had penetrating trauma (gunshot wound, 12; stab wound, 7), and four patients had blunt injury. Flexible laryngoscopy identified the injury in 8 of 12 patients (75%), and computer tomography scan was positive in 9 of 9 patients (100%). Twelve of the 19 patients with penetrating wounds were managed by primary repair, 4 had endotracheal intubation without surgical repair, and 3 were observed. No patient with a blunt tracheal injury required repair. Two had endotracheal intubation, and two were observed. A high index of suspicion is essential to identifying laryngotracheal injury. Computer tomography scan is a sensitive diagnostic test for laryngotracheal injury, and may be indicated despite normal flexible laryngoscopy. The decision to repair injuries or observe injuries is primarily based on respiratory distress and associated injuries.
喉气管创伤危及生命。我们确定了1992年至1998年间的23例患者，其中喉部损伤12例、气管损伤8例、合并损伤3例。19例患者为穿透性创伤（枪伤12例、刺伤7例），4例患者为钝性损伤。12例患者中有8例（75%）通过可弯曲喉镜检查发现损伤，9例患者中有9例（100%）计算机断层扫描呈阳性。19例穿透性伤口患者中，12例接受了一期修复，4例未进行手术修复而行气管插管，3例进行观察。钝性气管损伤患者均无需修复。2例进行气管插管，2例进行观察。高度怀疑对于识别喉气管损伤至关重要。计算机断层扫描是喉气管损伤的敏感诊断检查，即使可弯曲喉镜检查结果正常也可能需要进行该项检查。决定修复损伤还是观察损伤主要基于呼吸窘迫和合并损伤情况。
