Tracheobronchial injuries in chest trauma: a 17-year experience

ABSTRACT Objective: to discuss the clinical and therapeutic aspects of tracheobronchial lesions in victims of thoracic trauma. Methods: we analyzed the medical records of patients with tracheobronchial lesions treated at the São Paulo Holy Home from April 1991 to June 2008. We established patients' severity through physiological (RTS) and anatomical trauma indices (ISS, PTTI). We used TRISS (Trauma Revised Injury Severity Score) to evaluate the probability of survival. Results: nine patients had tracheobronchial lesions, all males, aged between 17 and 38 years. The mean values of the trauma indices were: RTS - 6.8; ISS - 38; PTTI - 20.0; and TRISS - 0.78. Regarding the clinical picture, six patients displayed only emphysema of the thoracic wall or the mediastinum and three presented with hemodynamic or respiratory instability. The time interval from patient admission to diagnosis ranged from one hour to three days. Cervicotomy was performed in two patients and thoracotomy, in seven (77.7%), being bilateral in one case. Length of hospitalization ranged from nine to 60 days, mean of 21. Complications appeared in four patients (44%) and mortality was nil. Conclusion: tracheobronchial tree trauma is rare, it can evolve with few symptoms, which makes immediate diagnosis difficult, and presents a high rate of complications, although with low mortality.

摘要

研究目的：探讨胸外伤患者气管支气管损伤的临床与治疗特点。

研究方法：回顾性分析1991年4月至2008年6月于圣保罗圣家医院接受治疗的气管支气管损伤患者的病历资料。通过修正创伤评分（Revised Trauma Score, RTS）与解剖学创伤评分指标（损伤严重程度评分Injury Severity Score, ISS、PTTI）评估患者创伤严重程度，并采用创伤修正损伤严重度评分（Trauma Revised Injury Severity Score, TRISS）评估患者生存概率。

研究结果：本研究共纳入9例气管支气管损伤患者，均为男性，年龄介于17~38岁。各创伤评分均值分别为：RTS 6.8、ISS 38、PTTI 20.0、TRISS 0.78。临床表现方面，6例患者仅表现为胸壁或纵隔气肿，3例出现血流动力学或呼吸不稳定。患者从入院至确诊的时间跨度为1小时至3天。其中2例患者接受颈切开术，7例（77.7%）接受胸腔切开术，1例为双侧胸腔切开术。患者住院时长为9~60天，平均住院时长21天。4例患者出现并发症（占比44%），无死亡病例。

研究结论：气管支气管树损伤较为罕见，可仅表现为轻微症状，导致即时诊断困难；尽管该损伤的并发症发生率较高，但死亡率较低。