Moriwaki Yoshihiro, Sugiyama Mitsugi, Matsuda Goro, Toyoda Hiroshi, Kosuge Takayuki, Uchida Keiji, Fukuyama Hiroshi, Iwashita Masayuki, Morimura Naoto, Suzuki Junnichi, Yamamoto Toshiro, Suzuki Noriyuki
Critical Care and Emergency Center, Yokohama Ciyu University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
World J Surg. 2005 Jan;29(1):102-5. doi: 10.1007/s00268-004-7433-1.
Computed tomography (CT) has not been considered useful for early diagnosis of traumatized patients who could hardly hold their breath, particularly patients with tracheal injuries. However, the recent development of spiral CT has made it possible to acquire contiguous patient data, which eliminates the respiratory misregistration. Air is easily differentiated from surrounding tissues by striking contrast, and the trachea can therefore be well displayed by three-dimensional (3D)-CT. We consider that it is possible to show tracheal injury by 3D-CT. The aim of this study is to clarify the usefulness of 3D-CT for detecting the injury site of blunt tracheal injuries. The study was carried out in hemodynamically stable patients who were suspected of having tracheal injury based on clinical manifestations such as hemoptysis, or cervical subcutaneous, deep cervical, or mediastinal emphysema. Repeated bronchoscopy confirmed tracheal injury. The virtual images of the 3D-CT (3D-tracheography) were compared with the direct images of bronchoscopic findings. Five cases were examined. In patients with tracheal injury, bronchoscopy revealed laceration of the tracheal lumen or disruption and dislocation of the tracheal cartilage, partially coated by mucus and clot, findings that confirmed the diagnosis of tracheal injury. The virtual images of the 3D-tracheography clearly showed the injury as a defect in the tracheal wall or a depression in the wall. The site and size of injury shown in the 3D-tracheography were comparable with those detected by bronchoscopy. We succeeded in detecting tracheal injuries by 3D-CT imaging, the virtual images of which were comparable with the bronchoscopic findings. 3D-tracheography is a useful method for diagnosing the site and form of tracheal injury in hemodynamically stable patients.
计算机断层扫描（CT）对于那些难以屏气的创伤患者，尤其是气管损伤患者的早期诊断一直被认为没有用处。然而，螺旋CT的最新发展使得获取连续的患者数据成为可能，这消除了呼吸配准误差。空气与周围组织形成鲜明对比，易于区分，因此气管可以通过三维（3D）-CT很好地显示出来。我们认为通过3D-CT可以显示气管损伤。本研究的目的是阐明3D-CT在检测钝性气管损伤部位方面的实用性。该研究针对的是血流动力学稳定、根据咯血或颈部皮下、颈深部或纵隔气肿等临床表现怀疑有气管损伤的患者。反复支气管镜检查证实有气管损伤。将3D-CT的虚拟图像（3D气管造影）与支气管镜检查的直接图像进行比较。共检查了5例患者。在气管损伤患者中，支气管镜检查显示气管腔内有撕裂或气管软骨断裂和脱位，部分被黏液和血凝块覆盖，这些发现证实了气管损伤的诊断。3D气管造影的虚拟图像清楚地显示损伤为气管壁的缺损或壁上的凹陷。3D气管造影显示的损伤部位和大小与支气管镜检查发现的相当。我们通过3D-CT成像成功检测到气管损伤，其虚拟图像与支气管镜检查结果相当。3D气管造影是诊断血流动力学稳定患者气管损伤部位和形态的一种有用方法。
