外伤性支气管断裂的救治

目的探讨严重胸部损伤中支气管损伤的早期诊断和急诊手术治疗方法。方法回顾分析21例支气管损伤的临床特点、损伤部位、早期诊断和急诊手术治疗的方法,其中男性16例,女性5例;平均年龄37岁(18～69岁);主支气管损伤6例,叶支气管损伤15例;临床表现均有呼吸困难、皮下气肿、气胸;常规X线胸片检查,其中典型肺坠落征7例,CT三维重建明确支气管断裂4例。结果 21例均在24h内急诊行剖胸探查术,行支气管修补或吻合术17例(其中1例支气管严重挫裂伤支气管修补术后出现支气管狭窄再次手术切除肺叶),因支气管和肺组织严重挫伤行左上叶切除术3例、右上叶切除术1例。19例术后恢复良好,2例死于严重合并伤。结论伴有支气管损伤的严重胸部创伤患者通常需要急诊手术治疗,早期明确支气管损伤诊断和损伤部位是急诊手术治疗的重要依据。手术应最大限度保护肺功能,尽可能行支气管修补或吻合术,避免肺切除术;但是如果支气管严重挫裂伤、累及长度较长,或者肺组织严重不可逆性损伤、累及范围较广,应果断行肺叶切除术。

Treatment of traumatic bronchial rupture

Objective To explore the diagnosis and treatment of traumatic bronchial rupture. Methods Clinical manifestation, injury site, early diagnosis, and emergency surgical treatment method were retrospectively an- alyzed. There were 16 males and 5 females,with an average of 37 years （ 18-69 years）. There were 6 cases of main bronchial injury,21 cases of lobar bronchus injury. All patients were found dyspneic respiration,cutaneous emphysema and aeropleura;routine chest X-ray examination showed 7 cases of fallen lung syndrome and chest computed tomography { CT） with 3-dimensional reconstruction techniques demonstrated 4 cases of bronchus rupture. Results Exploratory thoracotomy was emergently performed within 24 hours for the 21 patients. Bronchus repair or anastomosis was applied in 17 patients ,resection of left upper lobe in 3 patients with severe contused wound in bronchus and lung tissue, resection of fight upper lobe in 1 case. Good postoperative recovery was observed in 19 patients and 2 patients died due to severe combined injury. Conclusion Commonly severe chest injury patients combined with bronchus injury require emergency surgical treatment and early precise diagnosis of the bronchus injury and the injury site is key to perform emergency surgery. During the surgery treatment process, doctors should try to preserve lung function, perform bronchus repair or anastomosis, avoid lung resection; however, if there is severe lacerated wound of bronchus and severe irreversible damage of lung tissue, doctors should quickly Perform pulmonarv lobectomv.