Traumatic trachea and bronchial rupture repair

Tracheal and bronchial rupture often occur in severe chest impact or crush injuries. In recent years, with the increasing number of traffic accidents, closed trachea and bronchial rupture are not uncommon, and it is one of the causes of early death of chest trauma. The mechanism of its occurrence is not completely clear, and may be related to the following factors: 1 When the chest is subjected to sudden violent squeezing, its anteroposterior diameter is reduced, the transverse diameter is increased, and the two lungs are separated to the left and right. At the limit, the main bronchi can rupture. 2 When the chest is squeezed, the glottis is closed, and the trachea is squeezed between the sternum and the spine. The pressure in the trachea suddenly increases, far exceeding the pressure in the pleural cavity, and the airflow breaks through the tracheal wall and ruptures. 3 In anatomy, the annular cartilage and the tracheal ridge are relatively fixed, while the lungs hang on both sides. When the chest is injured, the lungs are squeezed to the sides and back, creating shear forces on the bronchi near the ridge, causing the part to rupture. Treatment of diseases: traumatic trachea and main bronchial injury Indication 1. After chest trauma, the lungs failed to re-expand after a complete thoracic closed drainage. 2. CT and fiberoptic bronchoscopy clearly diagnosed with tracheal or bronchial rupture, and the gap is greater than 1cm Preoperative preparation 1. Keep the airway open, adequate oxygen supply, closed thoracic drainage to reduce intrathoracic pressure, improve patient breathing difficulties. 2. Transfusion and rehydration to correct the general condition of the patient. 3. Apply antibiotics to control infection. 4. Delay the diagnosis, actively prepare, and operate as soon as possible. Surgical procedure 1. After entering the chest, carefully explore, find the location of the rupture, determine the extent and extent, relatively simple repair can meet the needs of most patients. Complex injuries involving the sacral or bilateral main bronchus should be safely repaired under extracorporeal circulation. 2. If the rupture of the rupture of the tracheal membrane or bronchi is not large, the edges are repaired and the suture is repaired intermittently. 3. If the bronchial rupture is large and the edges are not neat or completely broken, the ends should be trimmed and the opposite ends should be re-matched. 4. The anastomosis should avoid the rotation of the lumen and the alignment of the membrane. The four fixed points can be sutured first, the spacing of the suture needles should not be less than 0.15 cm, and the suture should be ligated outside the tube wall. Non-absorbent threads, fine nylon threads or absorbable sutures can be used. The use of absorbable lines helps to reduce postoperative granulation tissue formation and secondary anastomotic stenosis. 5. After the anastomosis is completed, the anesthesiologist has a significant leak after the anastomosis of the anastomologist, and the anastomosis is covered with a nearby pleura, intercostal muscle flap or other tissue. Rinse the pleural cavity and place the upper and lower drainage tubes.