晚期外伤性主支气管断裂的围术期处理

Perioperative management for late stage traumatic tracheobronchial ruptures

目的总结分析晚期外伤性主支气管断裂的围术期处理经验,促进术后患侧肺功能的恢复。方法回顾分析13例经手术治疗的晚期外伤性主支气管断裂的临床资料,包括术前胸部CT及纤维支气管镜检查结果、术中处理(包括麻醉、吻合技术等)、术后并发症防治(包括呼吸机使用、纤维支气管镜吸痰、防治复张性肺水肿、控制感染等措施)及随访结果。结果行主支气管重建术8例,主支气管重建术+胸膜剥脱术5例,肋骨骨折复位内固定5例(3例因局部胸廓塌陷明显,2例因骨折肋骨明显胸内错位)。本组无手术死亡患者。术后常见并发症为肺不张或肺膨胀不全、复张性肺水肿。结论晚期主支气管断裂患者应给予手术治疗,正确的术前评估、细致的术中处理及完善的术后管理,可最大限度地减少肺不张、肺水肿、肺部感染等并发症的发生,最大限度地恢复患肺呼吸功能。

Objective To summary and analyze the experience of perioperative management for late stage traumatic tracheobronchial ruptures,in order to promote lung function recovery of the diseased side after surgery.Methods The clinical data of 13 patients with late stage traumatic tracheobronchial ruptures underwent surgery were retrospectively analyzed.The clinical data included chest CT and fiber bronchoscopy before surgery,intraoperative treatment（includ ing anesthesia,anastomotic technique）,prevention of complications after surgery（including use of ventilator,aspiration of sputum through bronchoscopy,prevention of reexpansion pulmonary edema,control of infection）,and the results of following-up.Results There were 8 patients and 5 patients given the surgery of tracheobronchial reconstruction and the surgery of tracheobronchial reconstruction combined with pleural decortication respectively.5 patients were given the surgery of reduction and internal fixation for rib fracture.There was no death case because of surgery.The common complications after surgery were pulmonary closure,atelectasis and reexpansion pulmonary edema.Conclusion Patients with late stage traumatic tracheobronchial ruptures should be given surgery treatment.Correct preoperative eval uation,painstaking intraoperative treatment and excellent management after surgery can utmost reduce the risks of the complication development of pulmonary edema and pulmonary infection,and also can utmost recovery pulmonary function.