Hofmann H S, Rettig G, Radke J, Neef H, Silber R E
Department of Cardio-Thoracic Surgery, Martin-Luther-University Halle-Wittenberg, E-Grube-Str. 40, 06097 Halle, Germany.
Eur J Cardiothorac Surg. 2002 Apr;21(4):649-52. doi: 10.1016/s1010-7940(02)00037-4.
Iatrogenic tracheobronchial ruptures are seldom but severe complications after intubation or bronchoscopy. Therefore, we evaluated the reasons, the subsequent therapy and the outcome of patients with tracheal rupture, who were admitted to our hospital.
In a retrospective study we examined 19 patients (15 women, four men; 43-87 years) treated for acute tracheobronchial lesions. Eleven (58%) patients had a tracheobronchial rupture by single-lumen tube, four (21%) by double-lumen tube and two patients (10%) by tracheal cannula. A total of 47% of whom were carried out under emergency conditions. Two patients had a rupture due to a stiff bronchoscopy. Mean symptoms were mediastinal and subcutaneous emphysema. Two emergency collar incisions had been done.
The localization of ruptures was in all cases in the paries membranaceus, length: 1-7 cm (mean: 4.8 cm). The interval between the onset of symptoms and the diagnose differed widely (up to 72 h), nine (47%) diagnoses were made during intubation/bronchoscopy. One patient, with a small tear (1 cm) was treated conservatively with fibrin-glue. The other 18 patients had surgical repair through a thoracotomy. The postoperative mortality was determined with 42%, which was not dependent on the rupture but basically by the underlying diseases requiring intubation.
Iatrogenic tracheal rupture is a dangerous complication with potentially high postoperative mortality, mostly influenced by the underlying disease. Early surgical repair must be the preferred treatment.
医源性气管支气管破裂是插管或支气管镜检查后罕见但严重的并发症。因此,我们评估了我院收治的气管破裂患者的病因、后续治疗及预后。
在一项回顾性研究中,我们检查了19例(15例女性,4例男性;年龄43 - 87岁)接受急性气管支气管病变治疗的患者。11例(58%)患者因单腔管导致气管支气管破裂,4例(21%)因双腔管,2例(10%)因气管插管。其中47%是在紧急情况下进行的。2例患者因硬支气管镜检查导致破裂。平均症状为纵隔和皮下气肿。做了2例紧急颈部切口。
所有病例破裂均位于膜部,长度为1 - 7 cm(平均4.8 cm)。症状出现至诊断的间隔差异很大(长达72小时),9例(47%)诊断在插管/支气管镜检查期间做出。1例小裂口(1 cm)患者用纤维蛋白胶保守治疗。其他18例患者通过开胸手术进行修复。术后死亡率为42%,这并非取决于破裂情况,而主要取决于需要插管的基础疾病。
医源性气管破裂是一种危险的并发症,术后死亡率可能很高,主要受基础疾病影响。早期手术修复必须是首选治疗方法。