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钝性创伤所致气管支气管损伤的管理

[Management of Tracheobronchial Injuries due to Brunt Trauma].

作者信息

Tanaka Kazuhisa, Suzuki Hidemi, Yoshino Ichiro

机构信息

Department of General Thoracic Surgery, Chiba University, Chiba, Japan.

出版信息

Kyobu Geka. 2024 Apr;77(4):250-255.

Abstract

BACKGROUND

Tracheobronchial injuries resulting from blunt trauma are relatively rare among chest injuries. However, if these injuries are not managed properly, they can be fatal. The prognosis is intricately linked to the precise diagnosis and treatment. We herein report three cases of tracheobronchial trauma that required surgical intervention. Case 1:A 17-year-old male sustained injuries when his torso became entangled in heavy machinery. The diagnosis revealed a tear in the right main bronchus, which required transportation with left single- lung ventilation. The patient was treated by tracheobronchial reconstruction. Case 2:A 71-year-old male experienced trauma when his car collided with a utility pole. He was transported to the hospital after tracheal intubation due to a laceration of the tracheal membranous area. The site of the injury was closed with sutures. Case 3:A 17-year-old female who had been struck by a train suffered acute respiratory failure and was transported to the hospital after intubation. Veno-venous extracorporeal membrane oxgenation (VV-ECMO) was initiated in response to poor oxygenation. Complete rupture of the right middle bronchial trunk and laceration of the right main bronchial membrane were observed, and bronchoplasty was performed.

CONCLUSION

A swift and accurate diagnosis, coupled with timely and judicious therapeutic interventions, play a pivotal role in managing tracheal and bronchial injuries.

摘要

背景

钝性创伤导致的气管支气管损伤在胸部损伤中相对少见。然而,如果这些损伤处理不当,可能会致命。预后与精确的诊断和治疗密切相关。我们在此报告三例需要手术干预的气管支气管创伤病例。病例1:一名17岁男性,其躯干被卷入重型机械时受伤。诊断显示右主支气管撕裂,需要进行左单肺通气转运。患者接受了气管支气管重建治疗。病例2:一名71岁男性,其汽车与电线杆相撞时受伤。由于气管膜部撕裂,气管插管后被送往医院。损伤部位用缝线缝合。病例3:一名17岁女性被火车撞击后出现急性呼吸衰竭,插管后被送往医院。因氧合不佳启动了静脉-静脉体外膜肺氧合(VV-ECMO)。观察到右中间支气管主干完全断裂和右主支气管膜部撕裂,并进行了支气管成形术。

结论

快速准确的诊断,以及及时明智的治疗干预,在气管和支气管损伤的处理中起着关键作用。

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