Gómez-Caro Abel, Ausín Pilar, Moradiellos Francisco Javier, Díaz-Hellín Vicente, Larrú Emilio, Pérez Jose Antonio, de Nicolás José Luis Martín
Department of Thoracic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
J Trauma. 2006 Dec;61(6):1426-34; discussion 1434-5. doi: 10.1097/01.ta.0000196801.52594.b5.
The purpose of this study is to describe and assess the effectiveness of conservative treatment as the chosen treatment for tracheobronchial injury (TBI) management. This is a retrospective and descriptive study, which took place at a single center.
From January 1993 to July 2004, 33 TBIs were treated in our hospital. Eighteen (54.5%) were iatrogenic injuries and 15 (45.5%) were traumatic noniatrogenic injuries. Eighteen (55%) of the TBI patients were women and 15 (45.5%) were men, with a mean age of 46.7 +/- 23.4 years (range, 14-88 years). Eighteen (54.5%) of the injuries were caused by orotracheal intubation or tracheostomy, 13 (39.4%) by blunt trauma, and 2 (6.1%) by penetrating tracheal injuries. The average diagnostic delay was 18.29 +/- 19.8 hours. The mean injury size was 2.6 +/- 1.3 cm (range, 1-7 cm). Fourteen (42.4%) injuries were located in the cervical trachea, 8 (24.2%) in the thoracic trachea, 10 (30.3%) in the bronchi, and 1 (3%) involved both trachea and the main bronchi. Conservative treatment was applied in 20 (60.6%) of the 33 cases. Surgery should be performed in cases of esophageal-associated injuries, progressive subcutaneous or mediastinal emphysema, severe dyspnea requiring intubation, difficulty with mechanical ventilation, pneumothorax with an air leak through the chest drains, or mediastinitis.
Conservative medical or surgical treatments achieved good outcomes in 28 (84.8%) cases. Five patients (15.2%) died while in the hospital; 4 of these were medically treated and 1 was surgically treated. Mortality was related to older patients and patients that had been diagnosed during mechanical ventilation. Major symptoms (progressive subcutaneous emphysema, dyspnea, sepsis) were detected more often in cartilaginous injuries (p < 0.05). Conservative treatment was considered more effective in membranous injuries (p < 0.05), and these sorts of injuries were not related to a high mortality rate (p > 0.05). Mortality was not related to conservative treatment, sex, diagnostic delay, injury mechanism, location, or length of the TBI (p < 0.05).
Conservative treatment for TBI is effective regardless of the mechanism of production, length, or site of the injury. Conservative treatment should be carefully assessed in patients who meet strict selection criteria. Membranous injuries can be treated more often with a conservative approach, however, cartilaginous injuries should be treated surgically if major symptoms are detected.
本研究的目的是描述和评估保守治疗作为气管支气管损伤（TBI）管理的首选治疗方法的有效性。这是一项在单一中心进行的回顾性描述性研究。
1993年1月至2004年7月，我院共治疗33例TBI患者。18例（54.5%）为医源性损伤，15例（45.5%）为外伤性非医源性损伤。18例（55%）TBI患者为女性，15例（45.5%）为男性，平均年龄46.7±23.4岁（范围14 - 88岁）。18例（54.5%）损伤由口气管插管或气管切开术引起，13例（39.4%）由钝性创伤引起，2例（6.1%）由穿透性气管损伤引起。平均诊断延迟为18.29±19.8小时。平均损伤大小为2.6±1.3厘米（范围1 - 7厘米）。14例（42.4%）损伤位于颈段气管，8例（24.2%）位于胸段气管，10例（30.3%）位于支气管，1例（3%）累及气管和主支气管。33例中的20例（60.
