Altinok Tamer, Can Atilla
Department of Thoracic Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
Eurasian J Med. 2014 Oct;46(3):209-15. doi: 10.5152/eajm.2014.42. Epub 2014 Aug 26.
Tracheobronchial injury is one of cases which are relatively uncommon, but must be suspected to make the diagnosis and managed immediately. In such a case, primary initial goals are to stabilize the airway and localize the injury and then determine its extend. These can be possible mostly with flexible bronchoscopy conducted by a surgeon who can repair the injury. Most of the penetrating injuries occur in the cervical region. On the other hand, most of the blunt injuries occur in the distal trachea and right main bronchus and they can be best approached by right posterolateral thoracotomy. The selection of the manner and time of approaching depends on the existence and severity of additional injuries. Most of the injuries can be restored by deploying simple techniques such as individual sutures, while some of them requires complex reconstruction techniques. Apart from paying attention to the pulmonary toilet, follow-up is crucial for determination of anastomotic technique or stenosis. Conservative treatment may be considered an option with a high probability of success in patients meeting the criteria, especially in patients with iatrogenic tracheobronchial injury.
气管支气管损伤是相对少见的病例之一，但必须怀疑有此类损伤才能做出诊断并立即进行处理。在这种情况下，首要的初始目标是稳定气道、确定损伤部位，然后确定其范围。这大多可以通过由能够修复损伤的外科医生进行的可弯曲支气管镜检查来实现。大多数穿透性损伤发生在颈部区域。另一方面，大多数钝性损伤发生在气管远端和右主支气管，最佳的处理方法是右后外侧开胸手术。处理方式和时间的选择取决于是否存在其他损伤及其严重程度。大多数损伤可以通过采用简单技术（如单独缝合）来修复，而有些损伤则需要复杂的重建技术。除了注意肺部清洁外，随访对于确定吻合技术或狭窄情况至关重要。对于符合标准的患者，尤其是医源性气管支气管损伤患者，保守治疗可能是一种成功概率较高的选择。
