手术治疗气消化创伤：二十年存活率提高。

Operative Management of Aerodigestive Injuries: Improved Survival Over two Decades.

机构信息

R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.

RA Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.

出版信息

Am Surg. 2023 Dec;89(12):5982-5987. doi: 10.1177/00031348231180917. Epub 2023 Jun 7.

DOI:10.1177/00031348231180917

PMID:37283249

Abstract

INTRODUCTION

Non-iatrogenic aerodigestive injuries are infrequent but potentially fatal. We hypothesize that advances in management and adoption of innovative therapies resulted in improved survival.

METHODS

Trauma registry review at a university Level 1 center from 2000 to 2020 that identified adults with aerodigestive injuries requiring operative or endoluminal intervention. Demographics, injuries, operations, and outcomes were abstracted. Univariate analysis was performed, P < .05 was statistically significant.

RESULTS

95 patients had 105 injuries: 68 tracheal and 37 esophageal (including 10 combined). Mean age 30.9 (± 14), 87.4% male, 82.1% penetrating, and 28.4% with vascular injuries. Median ISS, chest AIS, admission BP, Shock Index, and lactate were 26 (16-34), 4 (3-4), 132 (113-149) mmHg, .8 (.7-1.1), and 3.1 (2.4-5.6) mmol/L, respectively There were 46 cervical and 22 thoracic airway injuries; 5 patients in extremis required preoperative ECMO. 66 airway injuries were surgically repaired and 2 definitively managed with endobronchial stents. There were 24 cervical, 11 thoracic, 2 abdominal esophageal injuries-all repaired surgically. Combined tracheoesophageal injuries were individually managed and buttressed. 4 airway complications were successfully managed, and 11 esophageal complications managed conservatively, stented, or resected. Mortality was 9.6%, half from intraoperative hemorrhage. Specific mortality: tracheobronchial 8.8%, esophageal 10.8%, and combined 20%. Mortality was significantly associated with higher ISS (P = .01), vascular injury (P = .007), blunt mechanism (P = .01), bronchial injury (P = .01), and years 2000-2010 (P = .03), but not combined tracheobronchial injury.

CONCLUSION

Mortality is associated with several variables, including vascular trauma and years 2000-2010. The use of ECMO and endoluminal stents in highly selected patients and institutional experience may account for 97.8% survival over the past decade.

摘要

引言

非医源性的呼吸道-消化道损伤较为少见，但可能致命。我们假设，管理水平的提高和创新疗法的采用使存活率得到改善。

方法

在一所大学的一级创伤中心，对 2000 年至 2020 年期间接受手术或内镜治疗的需要手术或内镜治疗的成人呼吸道-消化道损伤患者进行创伤登记回顾。提取人口统计学、损伤、手术和结果数据。进行单变量分析，P<.05 具有统计学意义。

结果

95 名患者有 105 处损伤：68 例气管损伤和 37 例食管损伤（包括 10 例联合损伤）。平均年龄 30.9（±14）岁，87.4%为男性，82.1%为穿透性损伤，28.4%合并血管损伤。损伤严重程度评分中位数为 26（16-34），胸部损伤严重程度评分中位数为 4（3-4），入院时血压中位数为 132（113-149）mmHg，休克指数中位数为.8（.7-1.1），血乳酸中位数为 3.1（2.4-5.6）mmol/L。有 46 例颈部和 22 例胸部气道损伤；5 例患者在危急情况下需要术前体外膜肺氧合。66 例气道损伤采用手术修复，2 例采用支气管内支架治疗。24 例颈段食管损伤、11 例胸段食管损伤、2 例腹段食管损伤均采用手术治疗。联合气管-食管损伤分别处理并加固。4 例气道并发症成功处理，11 例食管并发症保守治疗、支架或切除。死亡率为 9.6%，其中一半死于术中出血。具体死亡率：气管支气管 8.8%，食管 10.8%，联合 20%。死亡率与较高的损伤严重程度评分（P=0.01）、血管损伤（P=0.007）、钝性损伤机制（P=0.01）、支气管损伤（P=0.01）和 2000-2010 年（P=0.03）显著相关，但与联合气管-支气管损伤无关。