Baumgartner F, Sheppard B, de Virgilio C, Esrig B, Harrier D, Nelson R J, Robertson J M
Department of Surgery, Harbor-UCLA Medical Center, Torrance.
Ann Thorac Surg. 1990 Oct;50(4):569-74. doi: 10.1016/0003-4975(90)90191-8.
Tracheobronchial disruption is one of the less common injuries associated with blunt thoracic trauma. This injury can be life threatening, however, and failure to diagnose it early can lead to disastrous acute or delayed complications. Nine cases of tracheobronchial disruption in the setting of nonpenetrating thoracic trauma were seen at four Los Angeles trauma centers between 1980 and 1987. Mechanism of injury, presentation, diagnosis, and management of these patients were reviewed. Disruptions involved the trachea in 3 patients, the right bronchus in 5 patients, and the left bronchus in 2 patients. Tracheobronchial disruptions occurred in settings of high-energy impact-type injuries and were more likely to have associated injuries than they were to occur alone. Common presenting signs included subcutaneous emphysema, dyspnea, sternal tenderness, and hemoptysis. Radiographic findings were most commonly pneumothorax, pneumomediastinum, and clavicle or rib fractures. Rigid bronchoscopy and fiberoptic bronchoscopy were both highly accurate methods for diagnosis but only in the hands of trained cardiothoracic surgeons. Delay in diagnosis increased the likelihood of postoperative complications.
气管支气管断裂是钝性胸部创伤相关的较罕见损伤之一。然而，这种损伤可能危及生命，早期未能诊断可导致灾难性的急性或延迟性并发症。1980年至1987年间，洛杉矶的四家创伤中心共收治了9例非穿透性胸部创伤导致的气管支气管断裂患者。回顾了这些患者的损伤机制、临床表现、诊断和治疗情况。3例患者的损伤累及气管，5例累及右主支气管，2例累及左主支气管。气管支气管断裂发生于高能量撞击型损伤情况下，与其他损伤合并存在的可能性大于单独发生。常见的临床表现包括皮下气肿、呼吸困难、胸骨压痛和咯血。影像学表现最常见的是气胸、纵隔气肿以及锁骨或肋骨骨折。硬质支气管镜检查和纤维支气管镜检查都是诊断的高度准确方法，但仅适用于训练有素的心胸外科医生。诊断延迟会增加术后并发症的可能性。
