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摘要: 目的 探讨喉气管断裂伤治疗效果及相关并发症处理。 方法 回顾性分析2014年10月至2022年10月收治的10例外伤导致喉气管断裂患者的治疗情况。 结果 10例患者分别采用抗休克治疗、局部清创、气管-环状软骨或气管-气管吻合以及喉部软骨复位固定、局部组织瓣修复、Ⅱ期气道重建等治疗。9例患者Ⅰ期行气管-环状软骨或气管-气管吻合手术，其中5例患者行喉软骨骨折固定复位、放置碘仿纱条指套内支撑，放置时间(8.2±1.6) d；2例患者Ⅱ期行气管重建手术，均放置T形硅胶管内支撑3个月。2例行气管食管瘘修复手术；3例声带损伤者行声带缝合术；1例患者急诊进行抗休克治疗，1例患者行胸腔闭式引流治疗。10例患者术后均拔除气管套管，1例患者洼田饮水试验吞咽功能Ⅰ级，全部患者恢复经口进食。 结论 喉气管断裂早期治疗主要维持循环和呼吸功能；喉气管断裂治疗应该争取Ⅰ期重建完整气道结构，其中端端吻合重建气道以及喉部软骨骨折复位固定是气道结构重建取得良好效果的重要手段；对于合并气管食管瘘的患者，建议同期进行气管和食管结构重建。Abstract: Objective To investigate the therapeutic effect of laryngotracheal rupture injury and management of related complications. Methods A retrospective analysis was conducted on 10 patients with laryngotracheal rupture injury caused by trauma, admitted between October 2014 and October 2022. Results Anti-shock treatment, local debridement, tracheal-cricoid cartilage or tracheal-tracheal anastomosis, laryngeal cartilage reduction and fixation, local transposition flaps repair and phase-Ⅱ airway reconstruction were performed respectively on 10 patients. Nine patients underwent operations of tracheal-cricoid cartilage or tracheal-tracheal anastomosis, with five of these were performed by cartilage broken reduction and fixation, placed with intraluminal stents of iodoform gauze fingerstalls for (8.2±1.6) days. Tracheal reconstruction surgery was performed on 2 cases during phase-Ⅱ and both were placed with T-shaped silicone tube to support for 3 months. Two cases required tracheoesophageal fistula surgical repair, and vocal cord suturing was conducted for three vocal fold injuries. Anti-shock treatment was given to one emergency case and closed thoracic drainage treatment was given to another one. We removed the tracheal cannula from 10 patients after surgery and one case was diagnosed with Ⅰ-level swallowing function of sub-water test. All cases recovered to take food per-orally. Conclusion Maintenance of circulation and respiration functions is the major target during early treatment of laryngotracheal rupture. It should strive to complete the reconstruction of airway structure on phase-Ⅰ, among which end-to-end anastomosis to reconstruct airway and broken laryngeal cartilage reduction and fixation are the vital methods for airway structure reconstruction to achieve good results. It is suggested that the reconstruction of trachea and esophagus structures should be performed simultaneously to patients with tracheoesophageal fistula.
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Key words:
- neck trauma /
- trachea /
- tracheal stenosis
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表 1 患者资料
序号 原因 类型 喉气管损伤情况 合并伤 Ⅰ期治疗 Ⅱ期治疗 内支撑放置时间 愈后情况 1 刀割伤 开放 完全断裂 颈内静脉破裂、失血性休克、气管食管瘘 抗休克、颈内静脉修复、气管端端吻合、气管食管瘘修复、气管切开 无 拔管 2 刀割伤 开放 部分断裂 无 气管环状软骨吻合、气管切开 无 拔管 3 撞击伤 闭合 部分断裂 甲状软骨骨折、声带损伤、气胸 气管环状软骨吻合、软骨复位固定、内支撑植入(碘仿纱条指套)、胸腔闭式引流、声带缝合、气管切开 无 10 d 拔管 4 撞击伤 闭合 完全断裂 气管食管瘘、声带损伤 胸三角皮瓣修复气管食管瘘、颈部造瘘、声带缝合、气管切开 气管环状软骨端端吻合、内支撑植入(T管) 3个月 拔管 5 撞击伤 开放 完全断裂 环状软骨骨折、双侧声带固定、声带损伤 气管端端吻合、软骨复位内支撑固定(碘仿纱条指套)、声带缝合、气管切开 颈阔肌肌皮瓣修复、内支撑植入(T管) 3个月10 d Ⅰ期术后伤口感染裂开、Ⅱ期术后饮水轻度呛咳，拔管 6 刀割伤 开放 部分断裂 环状软骨损伤 软骨复位、内支撑(碘仿纱条指套)、气管环状软骨吻合、气管切开 无 7 d 拔管 7 刀割伤 开放 部分断裂 环状软骨损伤 软骨复位、内支撑(碘仿纱条指套)、气管环状软骨吻合、气管切开 无 7 d 拔管 8 刀割伤 开放 部分断裂 环状软骨损伤 软骨复位、内支撑(碘仿纱条指套)、气管环状软骨吻合、气管切开 无 7 d 拔管 9 撞击伤 开放 部分断裂 单侧声带固定 气管端端吻合、气管切开 无 拔管 10 刀割伤 开放 部分断裂 无 气管端端吻合、气管切开 无 拔管 
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