Wu Ming-Ho, Tsai Yueh-Feng, Lin Mu-Yen, Hsu I-Lin, Fong Yaou
Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
Ann Thorac Surg. 2004 Apr;77(4):1211-5. doi: 10.1016/j.athoracsur.2003.08.003.
We reviewed the clinical courses and evaluated the surgical results of 7 patients with complete laryngotracheal disruption caused by blunt injury.
Seven patients with complete laryngotracheal disruption caused by blunt injury were successfully treated in a 13-year period. Six of the seven incidents involved men younger than 30 years on motorcycles. All but one had intact cutaneous tissue of the neck. Six of seven laryngotracheal disruptions were at the cricotracheal junction and the other was at the junction of second and third tracheal ring. In the emergency departments, 4 of these 7 patients underwent endotracheal intubation and three others underwent tracheostomy after failed intubation. Two of 7 patients underwent delayed surgery (posttrauma day 3 and day 5) because of delayed diagnosis. All patients underwent laryngotracheoplasty with (n = 3) or without (n = 4) concomitant tracheostomy.
Total hospital stays ranged from 9 to 28 days (average 15 days). Intensive care unit stay ranged from 2 to 10 days (average 5.8 days). All 7 patients had paralysis of bilateral vocal cords that were revealed by postoperative bronchoscopy. In 3 patients who underwent concomitant tracheostomy, the tracheostomy tubes were removed within 3 to 5 months after surgery. In the other 4 patients who underwent laryngotracheoplasty only, the endotracheal tube was used as an airway support for 2 to 6 days (average 3.5 days). All patients had patent airways. Vocal cord function partially recovered in one side (n = 6) or both sides (n = 1). Their voices were audible but still husky 5 months or 1 year later.
Complete laryngotracheal disruption can be treated by laryngotracheoplasty with or without concomitant tracheostomy, and phonation can be partially recovered.
我们回顾了7例因钝性损伤导致完全性喉气管断裂患者的临床病程，并评估了手术效果。
在13年期间，7例因钝性损伤导致完全性喉气管断裂的患者得到成功治疗。7例事故中有6例涉及年龄小于30岁骑摩托车的男性。除1例外，其余患者颈部皮肤组织均完整。7例喉气管断裂中有6例发生在环状软骨气管交界处，另1例发生在气管第二和第三软骨环交界处。在急诊科，这7例患者中有4例行气管插管，另外3例插管失败后行气管切开术。7例患者中有2例因诊断延误接受了延迟手术（伤后第3天和第5天）。所有患者均接受了喉气管成形术，其中3例同时行气管切开术，4例未行气管切开术。
住院总天数为9至28天（平均15天）。重症监护病房住院天数为2至10天（平均5.8天）。所有7例患者术后支气管镜检查均显示双侧声带麻痹。3例同时行气管切开术的患者，气管切开管在术后3至5个月内拔除。另外4例仅行喉气管成形术的患者，气管内插管作为气道支持使用2至6天（平均3.5天）。所有患者气道均通畅。1侧（n = 6）或双侧（n = 1）声带功能部分恢复。5个月或1年后，他们的声音可闻及，但仍沙哑。
完全性喉气管断裂可通过行或不行气管切开术的喉气管成形术进行治疗，发声功能可部分恢复。
