Stassen Nicole A, Hoth J Jason, Scott Melanie J, Day Carolyn S, Lukan James K, Rodriguez Jorge L, Richardson J David
Department of Surgery, University of Rochester, Rochester, New York 14642, USA.
Am Surg. 2004 Jun;70(6):522-5.
Laryngotracheal injuries are potentially lethal injuries whose diagnosis can be difficult. The purpose of this study was to delineate the effect of injury mechanism on the types of injury sustained and patient outcome. Patient records during a 7-year period were reviewed for injury mechanism, patient demographics, clinical presentation, patient evaluation, injury location, associated injuries, operative interventions, and outcome. Fifteen patients with laryngotracheal injuries were studied. Blunt injuries were more common (60%). Patient demographics, mortality, average length of stay, and Injury Severity Score were similar for both groups. Prevalent physical findings on examination included subcutaneous air (53%), hoarseness (47%), stridor (20%), and neck tenderness (27%). Diagnosis was confirmed by CT scan of the neck (66% blunt, 33% penetrating) or bronchoscopy (44% blunt, 66% penetrating). Injury location, patient disposition, and associated injures were the same for both groups. The most frequent operative intervention performed for both groups consisted of a primary airway repair via a collar incision within 8 hours of injury. Only patients with a laryngeal injury required concomitant tracheostomy regardless of mechanism. Blunt and penetrating neck injuries resulted in similar types of tracheal and laryngeal injuries. Anatomic location of the injury determined the need for tracheostomy. Regardless of mechanism, the overall outcome for patients with laryngotracheal injuries is good when injuries are recognized and treated expeditiously. A high level of suspicion must be maintained when evaluating all potential laryngotracheal injury patients irrespective of the mechanism of injury.
喉气管损伤是具有潜在致命性的损伤，其诊断可能存在困难。本研究的目的是阐明损伤机制对所遭受损伤类型及患者预后的影响。回顾了7年期间患者的记录，内容包括损伤机制、患者人口统计学资料、临床表现、患者评估、损伤部位、相关损伤、手术干预及预后。对15例喉气管损伤患者进行了研究。钝性损伤更为常见（60%）。两组患者的人口统计学资料、死亡率、平均住院时间及损伤严重程度评分相似。检查时常见的体征包括皮下气肿（53%）、声音嘶哑（47%）、喘鸣（20%）及颈部压痛（27%）。通过颈部CT扫描（钝性损伤66%，穿透性损伤33%）或支气管镜检查（钝性损伤44%，穿透性损伤66%）确诊。两组患者的损伤部位、患者处置及相关损伤情况相同。两组最常进行的手术干预均为在损伤后8小时内通过颈部切口进行一期气道修复。无论损伤机制如何，只有喉部损伤患者需要同时行气管切开术。钝性和穿透性颈部损伤导致的气管和喉部损伤类型相似。损伤的解剖位置决定了是否需要气管切开术。无论损伤机制如何，喉气管损伤患者若能得到及时识别和治疗，总体预后良好。在评估所有潜在的喉气管损伤患者时，无论损伤机制如何，都必须保持高度怀疑。
