緊急挿管時の気管膜様部損傷に対する緊急手術

Emergency Surgery for Iatrogenic Injury to the Trachea During Emergency Tracheal Intubation

気管内挿管に伴う気管・気管支損傷はまれな疾患であるが，縦隔炎や膿胸を合併することがあり，全死亡率は22％と高く重篤な合併症である1）．気管損傷の治療法には外科的治療と保存的治療があり，いまだに議論の余地がある．

An 86-year-old woman lost consciousness at home. Tracheal intubation was performed in the ambulance during transport to our hospital. Computed tomography （CT） showed right putaminal hemorrhage in her brain, right pneumothorax, and mediastinal emphysema. The patient underwent craniotomy after chest tube drainage. However, the subcutaneous emphysema worsened postoperatively. Chest CT revealed a 2 cm tracheal injury on the cranial side of the tracheal bifurcation. Since iatrogenic injury of the trachea by intubation was suspected, the patient underwent emergency surgery. A 4 cm longitudinal laceration was visible in the membranous portion of the trachea. Continuous suture using 4-0 polydioxanone was performed and the suture site was covered with thymic fat. Postoperative bronchoscopy revealed only a scar at the repair site. Tracheal intubation is a common routine medical procedure, but avoidance of tracheal injury requires close attention. In this case, early surgery achieved good results.