Management and outcome of bronchial trauma due to blunt versus penetrating injuries  

作　　者：Jin-Mou Gao Hui Li Ding-Yuan Du Jun Yang Ling-Wen Kong Jian-Bai Wang Ping He Gong-Bin Wei 

机构地区：[1]Department of Traumatology,Chongqing University Central Hospital,Chongqing Emergency Medical Center,Chongqing 400014,China [2]Department of Cardiothoracic Surgery,Chongqing University Central Hospital,Chongqing Emergency Medical Center,Chongqing 400014,China

出　　处：《World Journal of Clinical Cases》2022年第16期5185-5195,共11页世界临床病例杂志

摘　　要：BACKGROUND The number of patients with bronchial trauma(BT)who survived to hospital admission has increased with the improvement of prehospital care;early diagnosis and treatment should be considered,especially among blunt trauma patients,whose diagnosis is frequently delayed.AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs,and to elaborate the differences between them.METHODS All patients with BTs during the past 15 years were reviewed,and data were retrospectively analyzed regarding the mechanism of injury,diagnostic and therapeutic procedures,and outcomes.According to the injury mechanisms,the patients were divided into two groups:Blunt BT(BBT)group and penetrating BT(PBT)group.The injury severity,treatment procedures,and prognoses of the two groups were compared.RESULTS A total of 73 patients with BT were admitted during the study period.The proportion of BTs among the entire cohort with chest trauma was 2.4%(73/3018),and all 73 underwent thoracotomy.Polytrauma patients accounted for 81.6% in the BBT group and 22.9%in the PBT group,and the mean Injury Severity Score was 38.22±8.13 and 21.33±6.12,respectively.Preoperative three-dimensional spiral computed tomography(CT)and/or fiberoptic bronchoscopy(FB)were performed in 92.1% of cases in the BBT group(n=38)and 34.3% in the PBT group(n=35).In the BBT group,a delay in diagnosis for over 48 h occurred in 55.3% of patients.In the PBT group,31 patients underwent emergency thoracotomy due to massive hemothorax,and BT was confirmed during the operation.Among them,22 underwent pulmo-tractotomy for hemostasis,avoiding partial pneumonectomy.In this series,the overall mortality rate was 6.9%(5/73),and it was 7.9%(3/38)and 5.7%(2/35)in the BBT group and PBT group,respectively(P>0.05).All 68 survivors were followed for 6 to 42(23±6.4)mo,and CT,FB,and pulmonary function examinations were performed as planned.All patients exhibited normal lung function and healthy conditions except three who required reoperations.CO

关 键 词：Bronchial trauma Bronchial repair BLUNT PENETRATING ATELECTASIS PNEUMONECTOMY 

分 类 号：R655.3[医药卫生—外科学]