气管支气管破裂的诊断与治疗

The Diagnosis and Management of Traumatic Tracheobronchial Ruptures

目的探讨早晚期气管、支气管破裂的诊治方法,提高对该疾病的认识。方法北京协和医院1988年10月至2010年8月收治气管、支气管破裂患者19例,男9例,女10例;年龄8～48岁,中位年龄28岁。分析其临床特点,包括临床表现、胸部X线、CT、纤维支气管镜检查等;行气管修补术2例,气管造口1例,支气管重建8例,支气管修补7例,全肺切除1例。结果死亡2例,均死于多器官功能衰竭。17例患者经手术治疗后痊愈,术后动脉血氧饱和度(SaO2)较术前有明显改善(96.80%±1.59%vs.88.40%±3.90%,P<0.01)。治愈的17例随诊3个月～2年,无气道狭窄发生,无需要气道内放置支架或扩张的病例。结论气管、支气管破裂的诊断依靠外伤史,胸部X线,CT,纤维支气管镜检查;治疗采取气管、支气管重建或修补术,效果满意。

Objective To investigate the methods of diagnosis and treatment for early and late tracheobronchial rupture,in order to improve the understanding of this disease.Methods We retrospectively analyzed the records of 19 patients treated for traumatic tracheobronchial rupture in our hospital between October 1988 and August 2010.There were 9 males and 10 females with a median age of 28 years（ranged from 8 to 48 years）.We analyzed the clinical characteristics of the disease,including clinical presentation,and the results of chest X-rays,computed tomography（CT）,and fibro-bronchoscopy.There were 2 cases of tracheal repair,1 case of tracheostomy,8 cases of bronchial reconstruction,7 cases of bronchial repair,and 1 case of pneumonectomy.Results Seventeen patients were cured by operation and 2 patients died of multiple organ failure.Blood oxygen saturation resumed normal in most patients after operation（96.80%±1.59% vs.88.40%±3.90%,P〈0.01）.Post-operative follow-up time was ranged from 3 to 24 months,and no tracheobronchial stenosis was observed and no patients needed stent or dilatation for treatment.Conclusion The diagnosis of tracheobronchial rupture depends on history of trauma,chest X-ray,CT and fibro-bronchoscopy results.Surgical treatments should be based on the tracheobronchial reconstruction or repair,and the clinical outcome is satisfying.