Massard G, Rougé C, Dabbagh A, Kessler R, Hentz J G, Roeslin N, Wihlm J M, Morand G
Department of Thoracic Surgery, University Hospital of Strasbourg, France.
Ann Thorac Surg. 1996 May;61(5):1483-7. doi: 10.1016/0003-4975(96)00083-5.
Although long-term complications of intubation and tracheostomy are well documented, little has been reported on acute complications of airway access techniques.
Fourteen patients (1 male and 13 female patients) aged 15 to 80 years presented with tracheobronchial lacerations after single-lumen intubation (n = 9), double-lumen intubation (n = 1), or tracheostomy (n = 4).
A left bronchial laceration after double-lumen intubation was discovered and repaired intraoperatively. A tracheal laceration after single-lumen intubation was recognized during induction of anesthesia. The remaining 12 were diagnosed within 6 to 126 hours (median, 24 hours) after injury. All patients had mediastinal and subcutaneous emphysema. At endoscopy, 12 injuries were located in the thoracic trachea and 1 in the cervical trachea. Twelve underwent primary repair through a right thoracotomy (n = 11) or left cervicotomy (n = 1), and 1 was treated conservatively. Two patients with tracheostomy injury died postoperatively. All repairs healed well but one. The latter was performed 5 days after the injury; a dehiscence occurred, but healed spontaneously.
We conclude that prognosis of tracheal lacerations depends both on the general health of the patient and on the rapidity of diagnosis and treatment.
尽管插管和气管切开术的长期并发症已有充分记录，但关于气道建立技术的急性并发症报道较少。
14例年龄在15至80岁的患者（1例男性和13例女性），在单腔插管（n = 9）、双腔插管（n = 1）或气管切开术（n = 4）后出现气管支气管撕裂伤。
术中发现并修复了1例双腔插管后左支气管撕裂伤。1例单腔插管后气管撕裂伤在麻醉诱导时被发现。其余12例在受伤后6至126小时（中位数为24小时）内确诊。所有患者均有纵隔和皮下气肿。在内镜检查中，12处损伤位于胸段气管，1处位于颈段气管。12例行右胸切开术（n = 11）或左颈切开术（n = 1）进行一期修复，1例保守治疗。2例气管切开术损伤患者术后死亡。除1例修复外，其余修复均愈合良好。后者在受伤后5天进行修复，出现裂开，但自行愈合。
我们得出结论，气管撕裂伤的预后既取决于患者的一般健康状况，也取决于诊断和治疗的速度。
