Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH 43212, USA.
JAMA Otolaryngol Head Neck Surg. 2013 Apr;139(4):405-10. doi: 10.1001/jamaoto.2013.75.
Management of pediatric tracheal injuries is a controversial topic not well documented in the otolaryngology literature.
To present our case outcomes in 2 pediatric patients with tracheal injury and to review the literature on surgical vs conservative management of tracheal injuries in the pediatric age group.
Case series and literature review.
Tertiary referral pediatric hospital.
Morbidity and mortality outcomes.
The 2 tracheal injuries in the case studies were successfully managed with intubation, antibiotics, and careful monitoring without morbidity related to the tracheal injury.
A high level of clinical suspicion is necessary for the diagnosis of tracheal injuries. Both conservatively and surgically managed patients require serial chest and lateral neck plain radiographs to follow resolution of pneumomediastinum and pneumothorax. Both require surveillance of the airway with operative laryngoscopy and bronchoscopy, in addition to long-term follow-up. Surgical repair of trachea rupture, although resulting in shorter intubation, may require tracheotomy. Promising results have been reported in the literature for conservative management with a relatively small risk of airway stenosis without the complications associated with intrathoracic repair. Conservative management should be considered in the management of tracheal injuries in the pediatric population.
小儿气管损伤的处理是一个有争议的话题，在耳鼻喉科文献中没有很好地记录。
报告我们在 2 例小儿气管损伤患者中的病例结果，并回顾小儿气管损伤的手术与保守治疗的文献。
病例系列和文献回顾。
三级转诊儿科医院。
发病率和死亡率结果。
病例研究中的 2 例气管损伤通过插管、抗生素和仔细监测成功治疗，无与气管损伤相关的发病率。
对于气管损伤的诊断，需要高度的临床怀疑。无论是保守治疗还是手术治疗的患者都需要连续进行胸部和侧颈部平片，以观察纵隔气肿和气胸的消退情况。两者都需要通过手术喉镜和支气管镜进行气道监测，以及长期随访。尽管气管破裂的手术修复可以缩短插管时间，但可能需要气管切开术。保守治疗在小儿气管损伤的治疗中应予以考虑，其具有相对较小的气道狭窄风险，而没有与胸腔内修复相关的并发症。在文献中，保守治疗的结果令人鼓舞。
