气管支气管损伤的外科治疗

Surgical treatments of trauma on the trachea and bronchi

目的探讨严重胸部损伤中气管、支气管损伤的及时诊断和治疗方法。方法回顾分析23例气管支气管损伤的临床特点、损伤部位、及时诊断和治疗的方法。结果4例叶支气管断裂行肺叶切除术,1例左主支气管完全断裂行切除左全肺,另1例左主支气管完全断裂行左全肺切除。剩余17例,3例气管膜部裂伤经保守治疗痊愈,14例气管支气管损伤者手术治疗修补断裂的气管支气管,术后复查胸片肺膨胀均良好。全组23例无死亡,术后无支气管胸膜瘘发生,均痊愈出院。结论严重胸部创伤的患者通常伴有气管或支气管损伤。如不能及时明确诊断,极易导致管腔狭窄或闭锁,影响患者肺功能。纤维支气管镜检查是尽早明确气管支气管损伤诊断和损伤部位的有效方法。

Objective To explore the diagnosis and treatment of traumatic lesions of the trachea and bronchi. Methods The clinical features, location of traumatic lesions, diagnosis and treatment were reported in 23 cases. Results Our cases of bronchial fracture patients underwent lobectomy, one case of the left main bronchus with complete fracture of the left lung, another one case of fracture of the left bronchial with completely left lung resection. Among the remaining 17 cases, three cases of membranous tracheal laceration healed with conservative treatment, 14 cases of tracheobrochial injury were repaired the trachea and bronchi, lung expansions after operation are good by chest radiography. There was no death in the total 23 cases, and no bronchopleural fistulas after the operation,all the patients were cured and discharged. Conclusion Lesion of the trachea and the bronchi is of high frequency in severe chest trauma. It is difficult to recover from the narrowed bronchi or consolidation of lung if from early diagnosis and treatment was delayed. It is necessary to have bronchescopy on the patients of severe chest, which can give early diagnosis and definite location of air- ways lesion.