CAJ | 학술논문

　　目的探讨创伤性肺不张的早期诊断和治疗方法。方法回顾性分析2005年10月至2012年8月收治的68例创伤性肺不张病例的临床资料。结果68例占同期胸外伤的4．22％。钝性伤64例，穿透伤4例。肺不张原因：肺挫伤51例（合并连枷胸16例），支气管破裂17例。发生于非手术治疗胸部伤49例，发生于剖胸术前4例，术中4例，术后11例。获诊方法：术中4例，影像学检查和纤支镜检64例。全肺切除1例，肺叶即肺段切除7例，支气管吻合6例，肋骨悬吊牵引8例，肋骨内固定（Jucet架）11例次，呼吸机辅助治疗12例。死亡率5．9％（4/68），死因为失血性休克1例，严重颅脑伤1例，术后M ODS 1例，肺部严重感染致ARDS 1例。存活者中并发症23例：肺部感染16例，顽固性肺不张3例，限局性肺不张2例，ARDS 2例，均治愈。结论早期应反复影像学检查避免漏诊；支气管损伤的诊断，高质量CT优于纤支镜检；连枷胸早期正确的固定可降低该病发生率；叶以下支气管损伤建议行切除而非吻合术。
　　목적탐토창상성폐불장적조기진단화치료방법。방법회고성분석2005년10월지2012년8월수치적68례창상성폐불장병례적림상자료。결과68례점동기흉외상적4．22％。둔성상64례，천투상4례。폐불장원인：폐좌상51례（합병련가흉16례），지기관파렬17례。발생우비수술치료흉부상49례，발생우부흉술전4례，술중4례，술후11례。획진방법：술중4례，영상학검사화섬지경검64례。전폐절제1례，폐협즉폐단절제7례，지기관문합6례，륵골현조견인8례，륵골내고정（Jucet가）11례차，호흡궤보조치료12례。사망솔5．9％（4/68），사인위실혈성휴극1례，엄중로뇌상1례，술후M ODS 1례，폐부엄중감염치ARDS 1례。존활자중병발증23례：폐부감염16례，완고성폐불장3례，한국성폐불장2례，ARDS 2례，균치유。결론조기응반복영상학검사피면루진；지기관손상적진단，고질량CT우우섬지경검；련가흉조기정학적고정가강저해병발생솔；협이하지기관손상건의행절제이비문합술。
Objective To discuss the early diagnosis and treatment of Traumatic atelectasis .Methods The data of 68 cases with Traumatic atelectasis from October .2005 to August .2012 was analyzed retrospectively .Results Sixty-eight(4 .22% ) patients had atelectasis .Blunt injury in 64 ,penetrating injury in 4 .The reasons of atelectasis :pulmonary contusion in 51 ,combined with flail chest in 16 ;bronchial disrupture in 17 .Atelectasis occurred during the nonoperative treatment in 49 patients ,preoperatively in 4 ,in-traoperatively in 4 and postoperatively in 11 .diagnosis method :4 cases were diagnosed by thoracotomy ,64 cases were diagnosed by radiography and fibroptic bronchoscopy .pneumonectomy in 1 ,lobectomy in 7 ,bronchial anastomosis in 6 ,Suspended traction of ribs in 8 ,internal fixation of ribs(Jucet cage) in 11 case-times ,respirator treatment 12 .The mortality rate was 5 .9% (4/68) ,1 case died of associated severe cardiac and large blood vessel injuries ,1 case died of Craniocerebral injury ,1 case died of MODS and 1 case died of ARDS following severe pulmonary infection .Complication in 23 :pulmonary infection in 16 ,intractable atelectasis in 3 ,Limita-tions atelectasis in 2 ,ARDS in 2 ,all of them were cured .Conclusion Repeated Radiographic examination should be taken to avoid misdiagnosis;The diagnosis for bronchial disrupture ,High quality CT is better than fibroptic bronchoscopy ;For flail chest ,Early correct fixtion can reduce the incidence of the atelectasis ;To lobe bronchial disrupture ,lobectomy is a wise policy .