鈍的外傷による頸部気管完全断裂

Complete Tracheal Rupture of the Neck due to Blunt Trauma

鈍的外傷による気管・気管支損傷は，その80％以上が病院到着前に死亡する致死的な病態であり1），医療機関受診後も死亡率が30％と救命困難な疾患の一つである2）．われわれはロープの絞め上げによる頸部気管の完全断裂に対し，緊急で外科的気道確保を行い救命しえた1例を経験した．鈍的外傷による頸部気管完全断裂に関する臨床学的特徴について，文献的検討を加えて報告する．

A foreign national male in his 30s presented to our hospital after falling overboard. He appeared to have had a rope around his neck during the fall；however, no witnesses observed this. The patient was agitated in the emergency room and was walking around incessantly. He exhibited a cervical cord scar and hoarseness at the beginning of the examination and developed dyspnea and bloody phlegm 40 minutes after arrival. Sudden respiratory deterioration occurred, and oral intubation was performed under sedation with 30 mg midazolam. Chest computed tomography （CT） revealed bilateral pneumothorax and complete transection of the cervical trachea, with tube deviation into the mediastinum. After bilateral drainage of the thoracic cavity, a tracheostomy was performed in the emergency room. The patient underwent tracheoplasty in the operating room 4 hours after arrival. He was extubated on postoperative day （POD） 10；however, bilateral recurrent nerve palsy persisted. The patient was discharged on POD 16.