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首页> 外文期刊>Interactive cardiovascular and thoracic surgery >Tracheobronchial injuries. Conservative treatment
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Tracheobronchial injuries. Conservative treatment

机译：气管支气管损伤。保守治疗

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摘要

Tracheal lacerations are iatrogenic, localized, low impact injuries with longitudinal tears (in about 1:20,000 intubations). In contrast traumatic tracheobronchial ruptures are high velocity injuries with horizontal transections. Between 1986 and 2002, we treated 27 tracheobronchial injuries (8 bronchial 3 of them iatrogenic, 19 tracheal 17 of them iatrogenic (+ 1 horizontal rupture + 1 tracheoesophageal stabbing)). Extension of the tears 5-12 cm. All bronchial ruptures, the tracheal rupture as well as six iatrogenic tracheal tears have been managed operatively. All the other underwent conservative treatment. Indications: (1) critically ill patients, (2) delay in diagnosis >72h, and (3) refusal of operation. It consists in endotracheal intubation for 5-9 days. This way we prevent pressure peaks as well as retention achieving a continuous control. Conservative group: 12/13 patients survived, neither stenosis nor megatrachea. Operative group: 1 patient died (MOF), 1 postoperative stenosis (Montgomery tube for 2 months). Tracheobronchial ruptures have to be operated. Lacerations show frequently discret clinical signs, but typical X-rays. They can be dealt with conservatively in the majority of cases as well as operatively. According to our experience, conservative treatment is safe and shows a mortality as low or lower than operative procedures.
机译：气管撕裂伤是医源性，局部性，低冲击性损伤，伴有纵向撕裂（在约1：20,000的插管中）。相反，创伤性气管支气管破裂是水平横断的高速损伤。在1986年至2002年之间，我们共治疗了27例气管支气管损伤（其中8例支气管性3例医源性，19例气管性17例医源性（+1次水平破裂+ 1例气管食管刺伤））。延伸眼泪5-12厘米。所有支气管破裂，气管破裂以及六个医源性气管撕裂均已得到手术治疗。所有其他患者均接受了保守治疗。适应症：（1）重症患者，（2）延迟诊断> 72h，和（3）拒绝手术。它包括气管插管持续5-9天。这样，我们可以防止压力峰值和保持力，从而实现连续控制。保守组：12/13例患者存活，既无狭窄也无气管狭窄。手术组：1例患者死亡（MOF），1例术后狭窄（蒙哥马利管治疗2个月）。气管支气管破裂必须进行手术。裂伤经常表现出离散的临床体征，但具有典型的X射线。在大多数情况下以及在操作上都可以保守地处理它们。根据我们的经验，保守治疗是安全的，其死亡率低于或低于手术方法。

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