创伤性主支气管断裂诊治.doc

创伤性主支气管断裂诊治 　赵永祥，范钦明，胡景云，张 权，胡冬煦，杨进福，朱 樾 【摘要】 目的 探讨外伤性主支气管断裂的诊断和手术治疗效果。方法 胸片、CT和纤维支气管镜是诊断支气管断裂的主要方法。结果 11例均行支气管断端吻合，术后肺膨胀良好，肺功能基本恢复。结论 主支气管断裂的诊断一旦确立，应尽快手术治疗，能获得良好的疗效。 【关键词】 支气管；破裂；诊断；外科；治疗 【Abstract】 Objective To study the diagnosis and surgical treatment for traumatic main bronchial rupture.Methods Chest Xrays，CT and fiberoptic bronchoscopy were the main means to confirm the diagnosis.Bronchial endtoend anastomosis were performed in 10 patients and pneumonectomy on one case because of infection.Results All the lungs were well ventilated and lung function recovered.Conclusion Main bronchial rupture occurs relatively rarely.Early diagnosis and operative intervention save lives. 【Key words】 bronchi；rupture；diagnosis；surgery；treatment 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