外傷性気管・気管支損傷の治療経験

Management of Tracheobronchial Injuries due to Brunt Trauma

胸部外傷の中で気管・気管支外傷は比較的まれであるが，処置を誤ると致命的になりうる．的確な診断と治療が予後を左右する．外傷性気管・気管支外傷に対して手術を施行した3例について，文献的考察を加えて報告する．

Background：Tracheobronchial injuries resulting from blunt trauma are relatively rare among chest injuries. However, if these injuries are not managed properly, they can be fatal. The prognosis is intricately linked to the precise diagnosis and treatment. We herein report three cases of tracheobronchial trauma that required surgical intervention.

Case 1：A 17-year-old male sustained injuries when his torso became entangled in heavy machinery. The diagnosis revealed a tear in the right main bronchus, which required transportation with left single-lung ventilation. The patient was treated by tracheobronchial reconstruction.

Case 2：A 71-year-old male experienced trauma when his car collided with a utility pole. He was transported to the hospital after tracheal intubation due to a laceration of the tracheal membranous area. The site of the injury was closed with sutures.

Case 3：A 17-year-old female who had been struck by a train suffered acute respiratory failure and was transported to the hospital after intubation. Veno-venous extracorporeal membrane oxgenation （VV-ECMO） was initiated in response to poor oxygenation. Complete rupture of the right middle bronchial trunk and laceration of the right main bronchial membrane were observed, and bronchoplasty was performed.

Conclusion：A swift and accurate diagnosis, coupled with timely and judicious therapeutic interventions, play a pivotal role in managing tracheal and bronchial injuries.