小儿外伤性支气管断裂的诊断与治疗

Diagnosis and Treatment of Traumatic Bronchial Rupture in Children

目的:分析小儿支气管断裂的原因、分型、临床特点及治疗。方法:全组11例小儿外伤性支气管断裂分别占同期入院小儿胸外伤和外伤性支气管断裂的1.1%和3.2%。小儿外伤性支气管断裂以Ⅱ型多见,占63.6%。其主要临床症状为咳嗽、咯血、皮下气肿。有1/3患儿伤后 X 线胸片无气胸改变,极易误诊。结果:11例皆采用手术治疗,8例行支气管成形术,2例行支气管成形并气管下端侧壁肋间肌瓣修补,1例成形一个月后因吻合口狭窄、肺化脓症行全肺切除。全组除1例因呼吸衰竭死于手术后6小时外,其余10例均痊愈出院。随访中2例失访,8例已存活1～15年。结论:及早正确的诊治、熟练的手术技巧、良好的术后护理是治疗本病的关键。

Objective:To analyze the cause,type,clinical features and treatment of traumatic bronchial rupture in children.Materials:Eleven patients were admitted and accounted for 1.1% of children with thoracic injury and 3.2% of the in-patients with traumatic bronchial rupture at the same period.Results:All patients underwent operation,including bronchoplasty in 8 cases,bron- choplasty plus intercostal muscular flap repairing the low part bronchus in 2,and pneumonectomy in one(due to anasromotic stenosis and pulmonary abscess formation one month after bronchoplas- ty).The course of 10 cases was uneventful except one died of respiratory failure 6 hours after op- eration.Eight patients have got well during a follow-up for 1-15 years(only 2 lost contact).Con- clusions:The satisfactory treatment for pediatric traumatic bronchial rupture depends on early di- agnosis,skillful operation and proper postoperative management.