Rose E, Schmitt M, Lotte E, Derelle J, Bichet G, Fauve M
Chir Pediatr. 1985;26(5):294-9.
The authors report three cases of tears in the tracheal or bronchial membrane in children resulting from an accidental external trauma of the trachea. Those children ranged from 3, to 5 and 10 years old. Those lesions showed a clinical gaseous syndrome associated with mediastinal and subcutaneous emphysema, in one of these cases complicated by unilateral pneumothorax and pneumomediastinum. After a symptomatic resuscitation, tracheobronchial endoscopy gives evidence each time of a crack of the posterior face of the trachea = cervix trachea in one case, end of the thorax trachea in the two other cases. Among them one was injured at the stem bronchi. These tracheobronchial lesions were treated nonoperatively and had a post-operative course uncomplicated. The author's attitude--except in case of extreme urgency--in front of a severe, isolated cervix thorax contusion in children, is to give systematically the indication for tracheobronchial endoscopy, in the view of knowing whether there is a tracheobronchial lesion or not and, if so, to five precisions about its location, its anatomic size, and its type (tear, fracture, disruption). An endoscopy performed immediately after cardiorespiratory rebalancing imposes the therapeutic conduct to be adopted, which is not always operative. Such is the case for the authors, especially in the case of children for whom the diagnosis of tracheobronchial lesion is sure, and in whom the stability of the vital signs are doubtless. In such cases, one is imposed not to operate.(ABSTRACT TRUNCATED AT 250 WORDS)
作者报告了3例儿童因气管意外外伤导致气管或支气管膜撕裂的病例。这些儿童年龄在3岁、5岁和10岁。这些损伤表现为与纵隔和皮下气肿相关的临床气体综合征，其中1例合并单侧气胸和纵隔气肿。经过对症复苏后，气管支气管内镜检查每次都能发现1例气管后壁（气管颈段）破裂，另2例为胸段气管末端破裂。其中1例在主支气管处受伤。这些气管支气管损伤采用非手术治疗，术后病程无并发症。作者的态度是——除非情况极其紧急——对于儿童严重的、孤立的胸廓颈部挫伤，为了了解是否存在气管支气管损伤，如果存在，明确其位置、解剖大小和类型（撕裂、骨折、断裂），应系统地进行气管支气管内镜检查。心肺功能恢复平衡后立即进行的内镜检查决定了应采取的治疗措施，而这并不总是手术治疗。作者就是如此，特别是对于那些气管支气管损伤诊断明确且生命体征稳定的儿童。在这种情况下，不应进行手术。（摘要截取自250字）
