外伤性胸段气管膜部破裂1例报道及文献复习  

Traumatic Rupture of the Thoracic Tracheal Membrane:One Case Report and Literature Review

作　　者：戴艺双[1] 孙旭日[2] Dai Yishuang;Sun Xuri(Outpatient Operating Room,the Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362000;Department of Critical Care Medicine,the Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian 362000)

机构地区：[1]福建医科大学附属第二医院门诊手术室,福建泉州362000 [2]福建医科大学附属第二医院重症医学科,福建泉州362000

出　　处：《现代医用影像学》2023年第12期2221-2224,共4页Modern Medical Imageology

摘　　要：目的:探讨外伤性胸段气管膜部破裂的诊疗体会。方法:回顾性分析我院收治一例外伤性胸段气管膜部破裂患者的临床表现、实验室检查、影像学检查和诊疗资料。结果:患者,男性,50岁,以“外伤后全身多处疼痛、出血伴气促8小时”入院,临床表现有外伤后颈部、胸部等多处疼痛,伴有咳嗽、咯血和气促,查体颈、胸部皮下捻发感,颈部压痛明显,胸部CT检查见颈部、上纵隔气肿,给予保持呼吸道、吸氧、止痛、抗感染等治疗,患者颈胸部皮下气肿进展、呼吸困难加重,纤维支气管镜见气管膜部近隆突一纵行全层裂伤长约4cm,局部渗血,胸外科行右侧开胸探查,术中见气管膜部长约4cm纵行破裂口,下缘达隆突上方0.5cm,行气管膜部破裂修补联合带蒂前锯肌肌瓣覆盖术,术后患者病情恢复,症状及体征消失,转耳鼻咽喉科行上、下颌骨骨折手术,最终痊愈出院。结论:外伤性胸段气管膜部破裂临床少见,发病急,病情重,来势凶险,出现纵隔气肿应高度可疑气道损伤,胸部CT检查可初步判断气管破裂部位及大小,气管镜检查可进一步明确诊断,一经确诊,若存在手术适应证,应尽早行气管膜部破裂口修补术,联合带蒂前锯肌肌瓣覆盖可防止术后气管瘘。Objective:To explore the experience of diagnosis and treatment of traumatic rupture of thoracic tracheal membrane.Methods:The clinical manifestations,laboratory examination,imaging examination and diagnosis and treatment data of a patient with traumatic rupture of thoracic tracheal membranes in our hospital were retrospectively analyzed.Results:The patient,a 50-year-old male,was admitted to hospital with"multiple pain,bleeding and shortness of breath in the whole body for 8 hours after trauma".The clinical manifestations included multiple pain in the neck and chest after trauma,accompanied by cough,hemoptysis and shortness of breath.The subcutaneous twirling sensation in the neck and chest was observed during physical examination,and the neck tenderness was obvious.Subcutaneous emphysema of the neck and chest of the patient progressed and dyspnea worsened.A longitudinal full-layer laceration of about 4cm near the tracheal carina was observed by the fiberbronchoscope,with local bleeding.A right thoracotomy was performed.After the operation,the patient recovered,the symptoms and signs disappeared,and the upper and lower jaw fractures were operated on the nose and throat department,and finally recovered and discharged.Conclusion:Traumatic rupture of the tracheal segment of the thoracic segment is rare in clinic,with an urgent onset,serious condition and dangerous condition.The occurrence of mediastinal emphysema should be highly suspected of tracheal injury.Chest CT examination can initially determine the location and size of the tracheal rupture,and tracheoscopy can further confirm the diagnosis.Combined pedicled serratus anterior muscle flap can prevent postoperative tracheal fistula.

关 键 词：创伤 气管膜部破裂 呼吸衰竭 气管破裂修补术 带蒂前锯肌肌瓣覆盖术 

分 类 号：R655[医药卫生—外科学] R816.4[医药卫生—临床医学]