Surgical treatment of post-traumatic tracheobronchial injuries: 14-year experience


Balcı A. E. , Eren M. N. , EREN T. Ş. , Ülkü R.

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, cilt.22, ss.984-989, 2002

  • Cilt numarası: 22 Konu: 6
  • Basım Tarihi: 2002
  • Doi Numarası: 10.1016/s1010-7940(02)00591-2
  • Dergi Adı: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
  • Sayfa Sayısı: ss.984-989

Özet

Objective: Tracheobronchial injuries have different clinical pictures and high mortality unless aggressive treatment is used. We reviewed our surgical experience. Methods: The records of 32 patients from 1988 to 2002 were reviewed. Mean age was 22.3 years (range: 4-53). Three patients were female. Prominent symptoms were dyspnea, subcutaneous air and pneumothorax in chest X-rays. Associated injuries were seen in 22 patients (68.7%): most frequently in the lung parenchyma (11 patients) and esophagus (seven patients). Bronchoscopic detection of a rupture of the trachea or bronchus was the main indication for surgery. Results: Nineteen injuries (59%) were penetrating and 13 blunt (41%). The most common presenting sign of airway disruption was subcutaneous emphysema (25%) and stridor (22%). Of the 32 patients, 22 underwent bronchoscopic examination. Bronchography was used in three patients admitted during the late period. Surgical morbidity was 19.3%. Seven patients died (21.8%), of whom six had been operated on. In operations performed during the first 2 h of trauma, no mortality occurred. There were associated injuries in 100% of patients that died and in 60% of those that survived. The proportion (100 vs. 24%) and duration (2.8 vs. 11.6 days) of ventilatory support were lower in patients that survived than in those that died. Mean injury severity score of patients that died was 34.7 +/- 8.8 while it was 24.3 +/- 8.6 in those that survived. Tracheal stenosis developed in three patients (9.3%). Conclusion: In civilian life, tracheobronchial injuries occur relatively rarely. Early diagnosis and operative intervention save lives. Associated injury is an important mortality factor. (C) 2002 Elsevier Science B.V. All rights reserved.