Lei Jie, Zhao Jinbo, Tian Feng, Wang Xiaoping, Zhou Yongan, Li Xiaofei, Wang Jian
Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China.
J Thorac Dis. 2017 Jan;9(1):194-199. doi: 10.21037/jtd.2017.01.16.
Blunt main stem bronchial injuries are rare but potentially life-threatening injuries in clinical. The aim of this study was to sum up the experience on diagnosis and treatment of blunt main stem bronchial injuries.
This report retrospective1y analyzed eight cases of main stem bronchial injuries induced by blunt chest trauma between 2013 and 2016 in Tangdu Hospital, Fourth Military Medical University.
There were eight patients, including four men and four women. The definitive diagnosis was confirmed by fibrobronchoscopy. Mean time between injury and treatment in our hospital was 4.25 days (range, 1-12 days). Mean length of airway tear was 1.04 cm (range, 0.5-2 cm). In four patients there was an injury to the left main stem bronchus, in three patients to the right main stem bronchus and in one patient to the ambilateral main stem bronchus. Emergent operation was performed in two patients and elective operation in six patients. End to end bronchial anastomosis was performed via right thoracotomy in two patients and via left thoracotomy in three patients, and primary repair was performed via right thoracotomy in two patients and via left thoracotomy in the remaining one patient. There was no death in this group. Seven patients had no complications and were able to take part in normal activities. One patient suffered from anastomotic stricture after operation was healed by granulation tissue resection and cryotherapy under fibrobronchoscopy.
Fibrobronchoscopy is able to define the blunt main stem bronchial injuries precisely and surgical approach is the preferred method for patients with these life-threatening complications.
钝性主支气管损伤在临床上较为罕见,但可能危及生命。本研究旨在总结钝性主支气管损伤的诊断和治疗经验。
本报告回顾性分析了2013年至2016年第四军医大学唐都医院收治的8例钝性胸部创伤致主支气管损伤的病例。
8例患者中,男性4例,女性4例。经纤维支气管镜确诊。我院受伤至治疗的平均时间为4.25天(范围1 - 12天)。气道撕裂平均长度为1.04厘米(范围0.5 - 2厘米)。4例患者左主支气管损伤,3例患者右主支气管损伤,1例患者双侧主支气管损伤。2例患者行急诊手术,6例患者行择期手术。2例患者经右胸切口行支气管端端吻合术,3例患者经左胸切口行支气管端端吻合术,2例患者经右胸切口行一期修复术,其余1例患者经左胸切口行一期修复术。该组无死亡病例。7例患者无并发症,能够参加正常活动。1例患者术后出现吻合口狭窄,经纤维支气管镜下肉芽组织切除及冷冻治疗后愈合。
纤维支气管镜能够准确诊断钝性主支气管损伤,手术治疗是这类危及生命并发症患者的首选方法。