Marty-Ané C H, Picard E, Jonquet O, Mary H
Service de Chirurgie Thoracique, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France.
Ann Thorac Surg. 1995 Nov;60(5):1367-71. doi: 10.1016/0003-4975(95)00643-Y.
Tracheobronchial rupture after tracheal intubation has been infrequently reported. We report 6 cases of membranous tracheal rupture after endotracheal intubation treated at our institution over 7 years.
Overinflation of the tracheal cuff was speculated to be a frequent cause of the tracheal damage because the lesion was always a linear laceration of the posterior membranous wall. The diagnosis was suspected on the basis of common signs such as subcutaneous emphysema, respiratory distress, pneumomediastinum, and pneumothorax. Fiberoptic bronchoscopy was the best means of confirming the diagnosis and determining the location and extent of the lesion. In 5 patients, extensive laceration with severe respiratory disorders required emergent repair through a right posterolateral thoracotomy.
There were two postoperative deaths unrelated to the tracheal lesion. A patient with a small tracheal defect and favorable clinical presentation showed a rapid positive outcome after conservative treatment.
Tracheal intubation-related airway ruptures are rare but probably underestimated. Early recognition and emergent repair are essential, because failure to do so could result in potentially lethal events.
气管插管后气管支气管破裂的报道较少。我们报告了我院7年间收治的6例气管插管后膜性气管破裂病例。
气管损伤的常见原因推测为气管套囊过度充气，因为损伤总是后膜壁的线性撕裂。根据皮下气肿、呼吸窘迫、纵隔气肿和气胸等常见体征怀疑诊断。纤维支气管镜检查是确诊及确定病变位置和范围的最佳方法。5例患者因广泛撕裂伴严重呼吸障碍，需通过右后外侧开胸进行紧急修复。
有2例术后死亡与气管病变无关。1例气管缺损小且临床表现良好的患者经保守治疗后迅速取得了良好效果。
气管插管相关的气道破裂很少见，但可能被低估。早期识别和紧急修复至关重要，因为不这样做可能导致潜在的致命事件。
