Richardson J David
Department of Surgery, University of Louisville, KY 40292, USA.
J Trauma. 2004 Jan;56(1):30-6. doi: 10.1097/01.TA.0000108631.72315.78.
Tracheobronchial injuries are relatively uncommon, and few data are available on the long-term effects of their treatment.
All injuries involving the larynx and trachea, trachea alone, and mainstem bronchus (MSB) treated by one surgeon were followed if they survived 48 hours.
Sixty patients were treated from 1976 to 2001 for blunt and penetrating injuries: 6 laryngotracheal injuries, 27 tracheal wounds, and 27 injuries to the mainstem bronchus. Follow-up ranged from 1 to 26 years. One of six laryngotracheal wounds had a good result. One required tracheal resection and one required permanent tracheostomy. Patients who survived tracheal resection and end-to-end anastomosis had good outcomes; two had granulomata caused by permanent suture use. One patient treated by primary repair developed stenosis requiring resection. Fourteen patients with MSB injury were treated by pneumonectomy, eight of whom survived. Three developed stump leak/empyema and three had cor pulmonale on long-term follow-up. Ten patients had repair of blunt MSB injuries; two developed bronchial stenosis requiring pneumonectomy.
Laryngotracheal and MSB injuries often had less than optimal outcomes on long-term observation. Tracheal injuries treated by resection and end-to-end repairs had excellent outcomes. The data should be useful in counseling patients/families and planning follow-up strategies for patients with tracheobronchial injuries.
气管支气管损伤相对少见，关于其治疗的长期影响的数据较少。
由一名外科医生治疗的所有涉及喉与气管、单纯气管以及主支气管（MSB）的损伤患者，若存活超过48小时则进行随访。
1976年至2001年期间，共治疗了60例钝性和穿透性损伤患者：6例喉气管损伤、27例气管创伤以及27例主支气管损伤。随访时间为1至26年。6例喉气管创伤中有1例效果良好。1例需要气管切除，1例需要永久性气管造口术。气管切除并端端吻合术后存活的患者预后良好；2例因使用永久性缝线出现肉芽肿。1例接受一期修复治疗的患者发生狭窄，需要进行切除。14例主支气管损伤患者接受了肺切除术，其中8例存活。3例出现残端漏/脓胸，3例在长期随访中出现肺心病。10例钝性主支气管损伤患者接受了修复；2例发生支气管狭窄，需要进行肺切除术。
长期观察发现，喉气管和主支气管损伤的预后往往不尽人意。通过切除和端端修复治疗的气管损伤预后良好。这些数据对于为气管支气管损伤患者提供咨询以及制定随访策略具有参考价值。
