论文部分内容阅读
目的探讨颈部闭合性喉气管损伤的临床特点、诊断和治疗方法。方法对117例颈部闭合性喉气管损伤的临床资料进行回顾性分析。结果该病的主要致伤原因为汽车车祸和绳索勒伤74例,占63.2%。喉气管完全和部分断裂69例,占59%。主要临床表现是颈部及咽喉疼痛伴有不同程度呼吸困难、声音嘶哑或失音、咯血及血痰、吞咽困难、饮水发呛。最常见的体征是颈部皮下气肿、喉气管软骨下陷或移位畸形。采用紧急气管切开术76例(65%),78例(66.7%)立即行喉气管吻合术、气管修补或重建术及“T”形管扩张,术后早期死于伴随伤者2例,通气良好者74例,必须再次成形者2例。31例后遗喉气管瘢痕狭窄,皆采用喉裂开、喉气管成形术及“T”形硅胶管扩张术治疗痊愈。气管食管瘘同时修补或重建10例,失败4例,二次修补失败1例。结论①气管切开是紧急建立通气的最好方法;②及时手术修复并用“T”形硅胶管扩张0.5～1年,并注意预防“T”形管上下端肉芽生长、管内干痂阻塞、“T”形管上移、误咽等并发症,可获得较好的远期效果;③对于气管食管瘘应早期修复并鼻饲2周以上,有利于瘘孔愈合。
Objective To investigate the clinical features, diagnosis and treatment of neck closed laryngotracheal trauma. Methods The clinical data of 117 cases of closed neck laryngotracheal tube injury were retrospectively analyzed. Results The main cause of the disease was car accident and rope injury in 74 cases, accounting for 63.2%. Throat trachea completely and partially broken 69 cases, accounting for 59%. The main clinical manifestations were neck and throat pain with varying degrees of dyspnea, hoarseness or aphonia, hemoptysis and bloody sputum, difficulty swallowing, and drinking water. The most common signs of subcutaneous emphysema in the neck, laryngotracheal tube subluxation or displacement deformity. Twenty-six patients (65%) underwent emergency tracheotomy and 78 (66.7%) patients underwent immediate laryngeal tracheal anastomosis, tracheal repair or reconstruction and “T” For example, good ventilation in 74 patients, two patients must be re-formed. Thirty-one cases of laryngeal laryngotracheal scar were treated by laryngectomy, laryngotracheal tube angioplasty and “T” silicone tube dilatation. Tracheal esophageal fistula at the same time repair or reconstruction in 10 cases, 4 cases of failure, failed to repair a second case. Conclusion ① tracheotomy is the best way to establish ventilation urgently; ② timely surgical repair and use “T” silicone tube expansion 0.5 to 1 year, and pay attention to prevent the “T” shape of the upper and lower end of the granulation tube growth, dry tube Scab obstruction, “T” shaped tube on the move, swallowing and other complications, can obtain better long-term results; ③ for early tracheal esophageal fistula and nasal feeding for more than two weeks, is conducive to fistula hole healing.