Bobocea Andrei Cristian, Matache Radu, Codreşi Mihaela, Bolca Ciprian, Cordoş Ioan
Clinica Chirurgie Toracică I, Institutul de Pneumologie, "Marius Nasta", Bucureşti.
Pneumologia. 2011 Oct-Dec;60(4):225-8.
Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. A high index of clinical suspicion and accurate interpretation of radiological findings are necessary for prompt surgical intervention with primary repair of the airway. Delays in treatment increases the risk of partial to complete bronchial stenosis.
A 21 years old male was admitted to our hospital following a workplace accident. A chest radiograph showed bilateral pneumothorax, cephalic and mediastinal emphysema. Chest tubes were placed on each side, with full pulmonary expansion and remission of emphysema. Minimal lesions of the right main bronchus were found at fiberoptic bronchoscopy. Daily chest X-rays showed an uncomplicated recovery. A stenosis was suspected due to right lung pneumonia evolving under specific antibiotherapy. Right main bronchus posttraumatic stricture was diagnosed by fiberoptic bronchoscopy. He underwent a right lateral thoracotomy with sleeve resection of stenotic bronchi. Control bronchoscopy reveals main bronchus widely patent with untraceable suture line.
Main bronchus rupture in blunt chest trauma is an additive effect of chest wall compression between two solid surfaces, traction on the carina and sudden increase in intraluminal pressure. Symptoms may vary: soft air leak, pneumothorax or limited mediastinal emphysema. Bronchoscopy should be performed immediately or when available. Granulation tissue leads to progressive bronchial obstruction, with distal infection and permanent parenchymal damage. Sleeve resection of the stenosed segment is the treatment of choice and restores fully the lung function.
Rupture of main bronchus is a complication of blunt chest trauma. Flexible bronchoscopy is useful and reliable for early diagnosis of traumatic tracheobronchial injuries. Delayed diagnosis can lead to lung parenchyma alteration due to retrostenotic pneumonia. Resection and end-to-end anastomosis is the key of successful in these cases.
气管支气管破裂是钝性胸部创伤导致的最严重损伤之一。对于气道的一期修复进行及时的手术干预，需要高度的临床怀疑指数和对影像学检查结果的准确解读。治疗延迟会增加部分至完全性支气管狭窄的风险。
一名21岁男性在 workplace accident 后被送往我院。胸部X线片显示双侧气胸、头颈部和纵隔气肿。两侧均放置了胸管，肺完全复张且气肿缓解。纤维支气管镜检查发现右主支气管有轻微病变。每日胸部X线片显示恢复过程顺利。因在特定抗生素治疗下右肺肺炎进展而怀疑有狭窄。纤维支气管镜检查诊断为右主支气管创伤后狭窄。他接受了右侧开胸手术，对狭窄支气管进行袖状切除。对照支气管镜检查显示主支气管广泛通畅，缝合线难以追踪。
钝性胸部创伤导致的主支气管破裂是两个固体表面之间胸壁受压、隆突牵拉和管腔内压力突然增加的综合作用。症状可能各不相同：轻微漏气、气胸或局限性纵隔气肿。应立即或在有条件时进行支气管镜检查。肉芽组织会导致进行性支气管阻塞，伴有远端感染和永久性实质损伤。狭窄段的袖状切除是首选治疗方法，可完全恢复肺功能。
主支气管破裂是钝性胸部创伤的一种并发症。可弯曲支气管镜检查对于创伤性气管支气管损伤的早期诊断有用且可靠。延迟诊断可导致因狭窄后肺炎引起的肺实质改变。切除并端端吻合是这些病例成功的关键。
