鈍的外傷による右主気管支損傷,中間幹完全断裂の1救命例 LACERATION OF THE RIGHT MAIN BRONCHUS AND TRANSECTION OF THE INTERMEDIATE BRONCHUS FOLLOWING A BLUNT CHEST TRAUMA : REPORT OF SUCESSFULLY MANAGED CASE

この論文にアクセスする

この論文をさがす

著者

抄録

症例は, 26歳女性,乗用車とブロック塀に胸部を挟まれ当院救命センターに搬送された.来院時著明な呼吸困難を認め,胸部X線写真で気胸と縦隔気腫を認めた.胸腔ドレーンを挿入し持続吸引を行ったが,大量のair leakがあり,肺の膨張は全く得られなかった.気道の損傷を疑い緊急気管支鏡を施行すると,右主気管支膜様部に損傷を認めたが,それより末梢は出血のため観察不能であった.右後側方切開にて緊急手術を施行したが,術中所見では主気管支損傷の他に中間幹の完全断裂を認めた. 2カ所の損傷部を4-0吸収糸にて縫合した.術後経過は順調で, 1カ月後の気管支鏡では,狭窄所見は全く認めなかった.鈍的外傷による気管支損傷は,気管分岐部より2.5cm以内に好発すると言われているが,末梢気管支の損傷も合併している症例があることより,術前内視鏡および術中の注意深い観察が必要と考えられた.

A 26-year-old female was caught her chest wall between a wall and an automobile at a traffic accisent, was initialy treated at another hospital and transferred to our hospital on the same day. On admission, she was extremely dyspneic. Chest roentgenograms demonstrated right-sided pneumothorax. A chest tube was inserted, without improvement in the pneumothorax or her clinical condition, and a large air leak was noted. Fiberoptic bronchoscopy revealed laceration of the right main bronchus, but the distal airway condition could not be observed due to airway hemorrhage. Urgent right posterolateral thoracotomy was performed, and in addition to laceration of the right main bronchus, complete transection of the intermediate bronchus was found. The right main bronchus and intermediate bronchus were debrided, and anastomoses were performed using interrupted absorbable sutures. Her postoperative course was satisfactory, and postoperative bronchoscopic examination revealed good healing without any stricture. The key to successful outcome in treating patients with this condition is a high level of suspicion and the early use of fberoptic bronchoscopy by careful attention to peripheral regions of bronchi.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 58(5), 995-998, 1997-05-25

    Japan Surgical Association

参考文献:  17件中 1-17件 を表示

各種コード

  • NII論文ID(NAID)
    10008527261
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
ページトップへ