Schedlbauer Eva-Maria, Todt Ingo, Ernst Arne, Seidl Rainer O
Department of Otolaryngology at UKB, Free University of Berlin, Berlin, Germany.
Laryngoscope. 2009 Mar;119(3):571-5. doi: 10.1002/lary.20107.
Iatrogenic injuries to the trachea are rare, but life-threatening complaints. Causes and treatment methods have been described for adults, but there is no literature on aetiology and treatment in children. We performed a retrospective study to examine the frequency, aetiology, and treatment of iatrogenic injuries to the trachea in children and to develop guidelines for their treatment and prevention.
Retrospective study from 2000-2007 at a level I trauma centre. All iatrogenic injuries to the trachea between the cricoid cartilage and the level of the carina in children (ages 0-16) were included in the study.
Between 2000 and 2007, 18 tracheal injuries were treated, four of them in children (22%). The primary symptom in all cases was emphysema. Diagnosis was confirmed using flexible endoscopy. In all cases, the cause of the injury was intubation. Two cases of acute injury were treated conservatively by bridging the injury with a tube. Two cases were treated surgically by means of end-to-end anastomosis. In all cases, healing by first intention occurred. No stenoses were observed during follow-up endoscopy.
Acute tracheal ruptures in children can be treated conservatively by bridging the rupture with a tube. Injuries to the trachea in which the mucosa is damaged or in which other complications, such as fistulae, are present must be treated surgically. The prognosis for such injuries is good.
气管医源性损伤虽罕见，但会危及生命。成人气管医源性损伤的病因及治疗方法已有相关描述，但儿童气管医源性损伤的病因及治疗尚无文献报道。我们进行了一项回顾性研究，以探讨儿童气管医源性损伤的发生率、病因及治疗方法，并制定其治疗及预防指南。
对一家一级创伤中心2000年至2007年期间的病例进行回顾性研究。纳入研究的对象为0至16岁儿童环状软骨至隆突水平之间的所有气管医源性损伤。
2000年至2007年期间，共治疗了18例气管损伤，其中4例为儿童（占22%）。所有病例的主要症状均为肺气肿。通过纤维支气管镜检查确诊。所有病例中，损伤原因均为插管。2例急性损伤采用置管跨越损伤部位的保守治疗方法。2例采用端端吻合术进行手术治疗。所有病例均一期愈合。随访支气管镜检查未发现狭窄。
儿童急性气管破裂可采用置管跨越破裂部位的保守治疗方法。气管黏膜受损或存在瘘等其他并发症的损伤必须进行手术治疗。此类损伤预后良好。
