关于创伤性主支气管断裂的诊治.docVIP

关于创伤性主支气管断裂的诊治 通过创伤性主支气管断裂的诊治，探讨外伤性主支气管断裂的诊断和手术治疗效果。 Acute injuries of bronchial system are rare and life?threatening situations，which can cause acute asphyxia[1，2]. Main bronchial rupture，a rare but potentially fatal condition，results from blunt/penetrating chest and has different clinical pictures[3～6]，occurrences of these injuries are only about 0.8% of all chest injuries. Since 1994，we have treated totally 11 cases，the diagnosis and surgical treatment for these cases are reported here. 1 Clinical information 1.1 General information The information was obtained by reviewing the operative records and archive files from 1994 to 2003 at our hospitals. The group consisted of 11 patients (male：7 cases，female： 4 cases) with penetrating or blunt bronchial injuries who were revealed in the emergency department (see Fig.1，2). All injuries involved the main stem bronchi. The right main bronchial rupture consisted of 4 cases，while the left main bronchial 7 cases. The shortest time of trauma was 7 days，the longest time was one year and half. Clinical findings： the most common presenting signs of airway disruption were dyspnea，pneumothorax，mediastinum and subcutaneous emphysema in 8 cases，hemoptysis in 5 cases. In 7 patients the atelectasis were found in 10 days to 3 months after trauma. Radiology： chest X?ray showed that complete transaction of a main bronchus might result in the classic signs of atelectasis，“absent hilum” or a collapsing of the lung away from the hilus toward the diaphragm，known as the falling lung sign of kumpe. CT showed the site of stenosis and the secondary consequences of airway narrowing have been useful in the delayed setting and may directly reveal bronchial rupture or stenosis. Fiberoptic brochoscopy： the bronchial cutoff in 4 patients was found，location of bronchial stenosis，edema and the distance between the cutoff and bronchial bifuraction could be seen. 1.2 Surgical treatment Bronchial rupture were