Management of blunt tracheobrochial injuries: 15 cases

Abstract

Objective To summarize the experiences of diagnosis and treatment for blunt tracheobronchial injuries(BTI). Methods From January 1993 to December 2013, 15 patients were diagnosed with BTI and underwent surgical treatment at our hospital. Mean age of the 15 patients (11 men and 4 women) was 26.4±4.5 years. All the patients had a history of trauma, which included crushing injury in 8 cases, deceleration injury in 4, fall injury in 2, and traction-type injury in 1. BTI location: right main bronchus in eight cases, left main bronchus in four cases, upper trachea in one case, lower trachea with the right main bronchus in one case, and cervico-thoracic trachea with left main bronchus in one case. Thoracic computerized tomography was performed in 15 patients, which showed pneumothorax, subcutaneous emphysema, pneumomediastinum or falling lung sign of Kumpe. Preoperative fiberoptic bronchoscopy examination was performed in 15 cases, which included bronchial atresia in 9 cases, bronchial transection in 3 cases, laceration of trachea in 2 cases, and tracheal transection in 1 case. An elective surgical procedure after BTI was performed in 10 cases, and emergency surgery was performed in 5 cases. Tracheo-bronchial laceration repair were performed in 2 cases, tracheal end-to-end reanastomosis in 1 case, and bronchial end-to-end reanastomosis in 12 cases. Results There was no operative death, and one case was complicated with anastomotic stenosis. The average operation time was 205.7 ±41.3 minutes, and the average blood loss was 268.4 ± 109 ml. The postoperative hospital stay was 11.6 ±3.7 days on average. Follow-up was completed in 15 patients (mean, 29.3 months), and 15 patients were all symptomatic improvement. Conclusion The most common site of BTI was the right main bronchus near Carina parts. Although the diagnosis and treatment are often delayed, our findings indicate that chest CT and endoscopic findings could be used for the diagnosis of BTI. Surgical resection and reconstruction are effective methods to repair BTI successfully even many months after they occur. Often they do not require the resection of pulmonary parenchyma. Key words: Blunt tracheobronchial injuries; Surgical treatment; Diagnosis