闭合性创伤性喉部外伤的诊断与救治

目的探讨闭合性创伤性喉部外伤的临床特点,以期指导正确的诊断救治。方法回顾性分析2001年3月到2006年3月收治的35例闭合性创伤性喉部外伤的临床资料。其中扼伤10例,钝器撞击伤19例,挤压伤6例,伴有其他脏器损伤的多发外伤16例。本组均经纤维喉镜检查及喉部CT检查证实并诊断为闭合性创伤性喉部外伤。17例保守治疗,3例咽后壁血肿切排手术,7例气管切开;8例因喉软骨塌陷或变形导致呼吸困难,行低位气管切开后再行喉软骨复位术,2例喉软骨骨折经低位气管切开后行喉软骨复位术不理想,遂行喉软骨钢丝固定对位,恢复解剖结构,术后予鼻饲,均顺利拔除气管套管。结果死亡2例,其中1例死于重症颅脑损伤;1例死于甲状腺组织损伤致颈部大血肿,后为尸检证实。余33例均痊愈,无喉狭窄发生,其中2例一侧声带固定,对侧声带代偿后声嘶改善。结论闭合性创伤性喉部外伤的伤情复杂,多伴有合并伤,正确的诊断和紧急治疗是挽救病人生命、防止并发症发生的关键。

Diagnosis and Therapeutics of Closed Blunt Laryngeal Trauma

Objective To investigate the clinical characteristics of closed blunt laryngeal trauma for definite diagnosis and effective treatment.Methods A retrospective analysis was carried out in 35 patients with closed blunt laryngeal trauma,all of which were diagnosed by laryngofiberscopy and CT at laryngeal from March 2001 to March 2006,including 10 clutch injury,19 blunt impact injury,6 crush injury and 16 multiple trauma combined with other organ injury.Expectant treatment were carried out in 17 cases,hematomas discission at throat posterior wall in 3 cases,incision of trachea in 7 cases,in 8 cases laryngeal cartilage reposition after low-set incision of trachea because of dyspnea with cartilagines larynges collapse or deformation and in 2 cases wire lock at cartilagines larynges fracture in order to recover anatomic structure due to failure of laryngeal cartilage reposition after low-set incision of trachea.All cases were granted with nasogastric feeding and trachea cannula were pulled out favourably.Results Two cases died,among which one was died of severe craniocerebral injury and the other was died of large haematoma at cervix caused by thyroid tissue damage and confirmed by autopsy.The remaining 33 cases got recovery without laryngeal stenosis,of which two cases developed fixation of vocal cords at one side,then hoarseness was improved through compensation of vocal cord at the opposite side.Conclusions With complex condition of closed blunt laryngeal trauma and combining generally with associated injury,definite diagnosis and timely treatment are crucial to saving the life of patients and preventing complications.