Reece G P, Shatney C H
Department of Surgery, University of Florida College of Medicine, University Hospital, Jacksonville.
South Med J. 1988 Dec;81(12):1542-8. doi: 10.1097/00007611-198812000-00019.
The low incidence of blunt trauma to the cervical portion of the trachea limits management experience in most centers. Hence, we combined our patients with those in published reports containing essential information on injury, treatment, and results. Among 51 patients (93% male), ages ranged from 3 to 65 years. There were 32 complete transections, 15 partial transections, and four tears. There were associated injuries of the recurrent laryngeal nerve (49%), esophagus (21%), larynx (14%), and cervical spine (9%). Presenting signs and symptoms included subcutaneous emphysema in 84%, respiratory distress in 76%, hoarseness/dysphonia in 46%, and hemoptysis in 21%. Tracheostomy was the best means of airway control; 13 of 17 (76%) attempted oral/nasotracheal intubations failed, necessitating emergency tracheostomy. Five patients with no respiratory distress and minimal tissue injury were successfully managed without tracheal repair. Ten patients had tracheal repair without tracheostomy. The only poor result occurred in a patient with a treatment delay of several days. Tracheal repair with tracheostomy was used in 27 patients, with good results in 19. Two patients died of other injuries, and six patients (four with delayed repair) required subsequent tracheal reconstruction. Repair over a stent was used in seven patients, four of whom had satisfactory results. From this review we conclude that (1) the diagnosis of blunt trauma to the cervical trachea requires a high index of suspicion, since this injury can easily be overlooked; (2) tracheostomy (vs intubation or cricothyroidotomy) is the preferred means of airway control; (3) preoperative laryngoscopy/bronchoscopy should be done to assess vocal cord function, possible laryngeal damage, and level of tracheal injury; (4) good long-term results, measured by voice and airway quality, are best obtained by immediate repair of significant injuries.
气管颈部钝性创伤的低发生率限制了大多数中心的治疗经验。因此，我们将我们的患者与已发表报告中的患者合并，这些报告包含有关损伤、治疗和结果的重要信息。51例患者（93%为男性），年龄在3至65岁之间。有32例完全横断伤、15例部分横断伤和4例撕裂伤。伴有喉返神经损伤（49%）、食管损伤（21%）、喉部损伤（14%）和颈椎损伤（9%）。主要症状和体征包括皮下气肿（84%）、呼吸窘迫（76%）、声音嘶哑/发音障碍（46%）和咯血（21%）。气管切开术是控制气道的最佳方法；17例尝试经口/鼻气管插管中有13例（76%）失败，需要紧急气管切开术。5例无呼吸窘迫且组织损伤轻微的患者未进行气管修复而成功治疗。10例患者未行气管切开术进行了气管修复。唯一的不良结果发生在一名治疗延迟数天的患者身上。27例患者采用气管切开术进行气管修复，19例效果良好。2例患者死于其他损伤，6例患者（4例延迟修复）需要随后进行气管重建。7例患者采用支架置入修复，其中4例效果满意。通过本次综述，我们得出以下结论：（1）由于这种损伤很容易被忽视，因此诊断气管颈部钝性创伤需要高度的怀疑指数；（2）气管切开术（与插管或环甲膜切开术相比）是控制气道的首选方法；（3）术前应进行喉镜/支气管镜检查，以评估声带功能、可能的喉部损伤和气管损伤程度；（4）通过对严重损伤进行即时修复，以声音和气道质量衡量，可获得最佳的长期效果。
