CAJ | 학술논문

目的探讨开放性喉气管创伤的病因与治疗和疗效.方法回顾性分析1998-2012年就诊福建医科大学附属第二医院38例开放性喉气管创伤患者的临床资料及诊疗经过.其中1例于急诊科抢救无效死亡,37例先在急诊科急救后住院并采取不同治疗方法,术前或术中均行气管切开术.术后32例定期随访行影像学检查.结果除1例因颈总动脉破裂大出血抢救无效于急诊科死亡之外,其余37例均救治成功.行伤口清创缝合、咽喉成形术者20例(20/37,54.1％),咽喉成形术+扩张子放置术者8例(8/37,21.6％),另9例(9/37,24.3％)分别行镍钛记忆合金支架置入术2例、喉气管裂开+橡胶手套喉模置入喉气管成形术3例、喉气管裂开+直管硅胶管置入喉气管成形术1例、喉气管裂开咽喉成形术+食管气管瘘修补术3例.术后随访0.5～3年,成功拔管、呼吸通畅且吞咽正常者35例(35/37,94.6％),23例发音基本正常(23/37,62.2％),12例发音嘶哑(12/37,32.4％),2例因喉气管三度狭窄无法拔管转诊外院(2/37,5.4％).结论救治开放性喉气管创伤患者时,须防止休克、出血、窒息,在保证呼吸道通畅及生命体征稳定的情况下,尽早行咽喉气管成形修复术,预防各种并发症的发生,可获得良好治疗效果.
목적 탐토개방성후기관창상적병인여치료화료효.방법 회고성분석1998-2012년취진복건의과대학부속제이의원38례개방성후기관창상환자적림상자료급진료경과.기중1례우급진과창구무효사망,37례선재급진과급구후주원병채취불동치료방법,술전혹술중균행기관절개술.술후32례정기수방행영상학검사.결과 제1례인경총동맥파렬대출혈창구무효우급진과사망지외,기여37례균구치성공.행상구청창봉합、인후성형술자20례(20/37,54.1％),인후성형술+확장자방치술자8례(8/37,21.6％),령9례(9/37,24.3％)분별행얼태기억합금지가치입술2례、후기관렬개+상효수투후모치입후기관성형술3례、후기관렬개+직관규효관치입후기관성형술1례、후기관렬개인후성형술+식관기관루수보술3례.술후수방0.5～3년,성공발관、호흡통창차탄인정상자35례(35/37,94.6％),23례발음기본정상(23/37,62.2％),12례발음시아(12/37,32.4％),2례인후기관삼도협착무법발관전진외원(2/37,5.4％).결론 구치개방성후기관창상환자시,수방지휴극、출혈、질식,재보증호흡도통창급생명체정은정적정황하,진조행인후기관성형수복술,예방각충병발증적발생,가획득량호치료효과.
Objective To discuss the cause and treatment strategy for open laryngotracheal trauma.Methods The clinical data of 38 cases with open laryngotracheal trauma admitted from 1998 to 2012 were collected and analyzed.Of them,one patient died in emergency department despite energetic resuscitation,37 were hospitalized and given advanced treatment after life support measures in emergency department.They were treated with tracheotomy before or during operation.Of them,32 patients were regularly followed up for imaging studies.Result Except 1 patient died of exsanguination from carotid artery rupture,the other 37 survived after successful treatment.Twenty patients were treated with debridement and suture of the wounds and laryngoplasty (20/37,54.1％),8 patients were operated with laryngoplasty plus intraluminal stents implanted (8/37,21.6％) ; the rest 9 patients (9/37,24.3％) were separately given placement of nickel-titanium shape memory alloy stent (n =2),laryngofissure with rubber gloves throat models implanted and laryngoplasty (n =3),linear silicone tube implanted and laryngoplasty with trans-cervical approach (n =1) and tracheoesophageal fistula neoplasty with laryngoplasty and laryngofissure (n =3).The operated patients were followed-up for 0.5 to 3 years after discharge.Of them,35 patients (35/37,94.6％) had successful decannulation,breathing smoothly and swallowing normally,23 patients (23/37,62.2％) had almost normal pronunciation,12 patients (12/37,32.4％) had different degrees in hoarseness of voice,and 2 patients (2/37,5.4％) were referred to other hospital because of failure in extubation with severe stenosis of laryngotrachea.Conclusions When the patients with open laryngotracheal trauma were treated,the essential strategy was to prevent shock,hemorrhage,and asphyxia.In the case of patent respiratory tract and stable vital signs,laryngotracheal reconstruction should be carried out as soon as possible to prevent complications,thereby obtaining good therapeutic effect.