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山东大学学报(医学版)

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创伤性气管支气管断裂的外科治疗

张哲1,2,彭忠民,陈景寒,孟龙,杜贾军,王磊,王晓航,张林   

  1. 1. 山东大学山东省立医院胸外科, 山东 济南 250021;2. 青岛市市立医院胸外科, 山东 青岛 266011
  • 收稿日期:2006-04-29 修回日期:1900-01-01 出版日期:2006-10-24 发布日期:2006-10-24
  • 通讯作者: 张哲

ZHANG Zhe,PENG Zhong-min,CHEN Jing-han,MENG Long,DU Jia-jun.WANG Lei,WANG Xiao-hang,ZHANG Lin   

  • Received:2006-04-29 Revised:1900-01-01 Online:2006-10-24 Published:2006-10-24
  • Contact: ZHANG Zhe

摘要: 目的:探讨气管支气管断裂的外科诊治特点。方法:回顾性分析气管支气管断裂患者的临床特点、诊断及治疗经过,对32例气管支气管断裂患者就其伤情、手术要点及术后情况进行分析。结果:本组年龄14~55岁(平均35.2岁),以交通事故伤为主。5例气管断裂和14例支气管完全断裂者诊断后即手术,不全断裂13例中,4例患者一过性治愈,后又出现狭窄,损伤累及气道周径1/3以下且未达全层者3例,其中2例经保守治愈,其余均手术治疗。术后再狭窄3例,经纤支镜咬除肉芽组织而治愈1例,再手术2例。结论:气道断裂早诊断、及时手术是避免术后再狭窄的关键。对小于气道周径1/3的裂伤可先试行保守治疗。

关键词: 治疗结果 , 支气管, 创伤和损伤, 气管

Abstract: To seek out some proper diagnostic and therapeutic feature for improving the survival quality and avoiding missed diagnosis of traumatic tracheobronchial rupture. Methods: The traumatic condition, operation feature and operation results of 32 patients ranged 1455 years (mean 35.2 years old) were retrospectively analyzed. Most of the ruptures were caused by traffic accidents (22/31). Results: Endtoend anastomosis was performed immediately after diagnosis in 14 cases of bronchus being ruptured completely and 5 cases of trachea being ruptured, and conservation treatment in the other 13 cases of incomplete traumatic rupture. Only 2 patients were cured, the rest were treated by surgery, including 4 that had ever been cured through drainage but the bronchi were obstructed by granulation later. Three were left with stenosis after the first operation because of incomplete resection. One was cured by laser through bronchoscopy, the other two which showed no sensitive to laser were cured by resection. Conclusion: Tracheobronchoscopy is mandatory in assessing the definite diagnosis of tracheobronchial rupture. Early diagnosis and surgical repair are recommended. To remove granulation completely is essential for avoiding airway stenosis. Only very few cases whose lesion affect less than a third of the circumference and not involve the whole wall may be cured conservatively.

Key words: Trachea, Bronchi, Wounds and injuries, Treatment outcome

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