钝性支气管损伤18例临床分析  

Clinical analysis of 18 patients with blunt bronchial injuries

作　　者：张为民[1,2] 赵兴吉[1,2] 都定元[1,2] 谭远康[1,2] 孔令文[1,2] 

机构地区：[1]重庆市急救医疗中心 [2]重庆市第四人民医院心胸外科,重庆400014

出　　处：《重庆医学》2014年第23期3022-3024,共3页Chongqing medicine

摘　　要：目的总结钝性支气管损伤诊断和治疗经验。方法 2002年1月至2009年12月收治钝性支气管损伤患者18例。均经纤维支气管镜明确诊断,其中,主支气管损伤12例,叶支气管损伤6例。均采用外科手术治疗,其中,急诊手术15例,择期手术3例。手术方法包括支气管端端吻合术15例,裂伤修补术3例。结果本组无死亡病例。1例急诊行支气管裂伤修补术,术后3d修补处缺血坏死,切除坏死组织后行支气管端端吻合术。13例术后愈合良好,基本恢复正常活动。5例术后出现吻合口狭窄,4例纤维支气管镜下切除及液氮冷冻肉芽组织后缓解,1例疗效不佳,因反复狭窄及严重呼吸困难,术后6个月行肺叶切除术。结论纤维支气管镜检查能迅速明确诊断,早期外科手术是提高成功救治率的关键。Objective To sum up the experience on diagnosis and treatment of blunt bronchial injuries.Methods From January2002 to December 2009,18 patients with blunt broncheal injuries were admitted.The definitive diagnosis was confirmed by fibrobronchoscopy.Twelve patients suffered from main bronchial injuries and the remaining 6patients from lobe bronchial injuries.All patients managed with surgical therapies.Emergent operation was performed in 15 patients and elective operation in 3patients.End to end bronchial anastomosis was performed in 15 patients and primary repair in 3patients.Results There was no death in this group.One patient after emergent primary repair developed ischic necrosis in the repair site on 3the postoperative day and underwent resection of the necrotic tissue followed by end to end anastomsis.Thirteen patients had no complications and were able to take part in normal activities.Anastomotic stricture occurred in 5patients and managed with granulation tissue resection and cryotherapy.Four patients were healed but one patient underwent lobectomy 6months later as a result of recurrent stricture and severe dyspnea.Conclusion Fibrobronchoscopy is able to define the blunt bronchial injuries immediately.Early surgery after trauma can improve the successful rate of treatment.

关 键 词：钝性胸外伤 支气管损伤 支气管狭窄 

分 类 号：R641[医药卫生—外科学]