Treatment and Outcome of Traumatic Tracheobronchial Injuries

外傷性氣道損傷的治療與預後

10.29806/TM.200608.0004

吳青陽(Ching-Yang Wu)；劉永恆(Yun-Hen Liu)；吳怡成(Yi-Cheng Wu)；謝明儒(Ming-Ju Hsieh)；柯博仁(Po-Jen Ko)；朱彥(Yen Chu)；劉會平(Hui-Ping Liu)

外傷性氣道損傷 ； 氣道外傷 ； traumatic tracheobronchial injuries ； airway trauma

胸腔醫學

21卷4期（2006 / 08 / 01）

328 - 336

英文

背景：外傷性氣道損傷在臨床上雖是少見但近年來發生率有上升的趨勢。為了進一步瞭解氣道損傷的相關臨床處理，我們針對歷史文獻及本院實例作回溯性的分析並嘗試對氣道損傷的臨床處理流程作系統性的歸納。 方法：自2001十月到2005六月我們共處理十一位外傷性氣道損傷的病患。我們針對外傷性氣道損傷的臨床症狀表現、診斷方式、治療方式以及可能的併發症作回溯性的研究。 結果：在十一位外傷性氣道損傷的病患中，有六位是男性，有五位是女性；其平均年齡為43.9歲（9~85歲）。其臨床症狀表現與氣道受損的為置有密切關係。 最常見的重狀就是皮下氣腫。在病人生命徵象穩定之後，我們才針對可能相關的損傷作更一步的檢查。我們發現不論是鈍傷或是穿刺傷所引起的氣道損傷都有相當高的比率會伴隨其他損傷。所有病人都接受外科手術治療而且術後恢復良好，但有兩個病人在術後追蹤在吻合端出現肉芽組織增生。 結論：早期診斷以及早期處理對外傷性氣道損傷是很重要的。氣道損傷的致病變(morbidity)以及致死率(mortality)會因不同相關損傷而有所影響。若高度懷疑氣道損傷，在作更進一步檢查之前必須維持氣道通暢。在維持氣道通暢後才可以針對相關損傷所進一步的檢查。支氣管鏡可以提供更多更詳細的氣道損傷狀況提供外科醫師作適當的術前規劃。我們針對氣道損傷作適度的清創以及用可吸收線修補缺損。胸腔姿勢引流(intensive chest care)以及適當的呼吸治療(inhalation therapy)在氣道清潔(airway toilet)上是很重要的。術後應儘早拔管以及盡量避免正壓機械呼吸(positive-pressure ventilation)以免影響修補處的癒合。

Background: Traumatic tracheobronchial injuries are rare, but have been increasing in incidence in recent years. We summarize and analyze the presentations, management, and outcome of tracheobronchial injuries through a presentation of our experience and a review of the literature. Patients and methods: From October 2001 to June 2005, we managed 11 patients with tracheobronchial injuries due to both blunting and penetrating etiologies. Clinical presentations, diagnostic modalities, management, and complications were reviewed retrospectively. Results: Eleven patients with traumatic tracheobronchial injuries were identified: 6 were male and 5 were female, with a median age of 43.9 years (range, 9~85 years). Physical findings were closely related to the lesion site, and subcutaneous emphysema (6/11) was the most common clinical finding. All of our patients underwent a further survey of associated injuries after vital signs had been stabilized. High incidences of associated injuries were noted in both groups; however, there were no esophageal or great vessel injuries in our study. All patients received surgical treatment and recovered well, except 2 patients with anastomotic granulations in the serial follow-up. Conclusion: Early diagnosis and early management is crucial for traumatic tracheobronchial injury. The morbidity and mortality of tracheobronchial injury is influenced by associated injuries. Bronchoscopy can provide detailed information on airway injury and lead surgeons to choose the proper method. We performed debridement and mobilization of the airway prior to primary repair with absorbable suture. Intensive chest care and adequate inhalation therapy is important for airway toilet. Extubation should be performed as soon as possible to avoid positive-pressure ventilation injury.