Trakeobronşiyal Yaralanmalar: 15 Olguluk Bir Serinin Değerlendirilmesi


Kaptanoğlu M., Nadir A., Erbaş E., Gönlügür U. , Seyfikli Z., Doğan K., ...Daha Fazla

Turkish Thoracic Journal, cilt.2, ss.54-59, 2001 (Diğer Kurumların Hakemli Dergileri)

  • Cilt numarası: 2 Konu: 3
  • Basım Tarihi: 2001
  • Dergi Adı: Turkish Thoracic Journal
  • Sayfa Sayıları: ss.54-59

Özet

Bu makalede 1994-2001 y›llar›nda trakeobronfliyal yaralanmas› olan hastalar›n de¤erlendirilmesi, tan› ve tedavide karfl›lafl›lan güçlük - lerin ve çözümlerinin tart›fl›lmas› amaçland›. Trakeobronfliyal yaralanmas› olan 15 hastan›n kay›tlar› retrospektif olarak incelendi. Hastalar yaralanman›n türü, fizik muayene bul - gular›, tan› yöntemleri, yaralanman›n lokalizasyonu ve tedavi yöntemleri aç›s›ndan de¤erlendirildi. En genç hasta 1, en yafll›s› 58 yafl›nda, medyan yafl 15 idi. Etiyolojide künt toraks travmalar› %87’lik bir oranla ilk s›rada yer al - maktayd›. Tan› için 13 hastaya bronkoskopi yap›ld›. Bilgisayarl› tomografiyi (BT) künt toraks travmas› olgular›nda rutin olarak uygu - lanmamaktad›r, bu nedenle sadece geç atelektazi ile gelen 2 ve mediastinal amfizemi olan hastalardan 2’sine BT çekilmifltir. Hastalar›n 5’ine hemen, 5’ine ilk 24 saatte müdahale edilmifltir, 3 hasta konservatif yöntemlerle takip edilirken 2 hasta ise gecikmifl olarak tedavi edilmifltir. Hastalar›n %62’sinde bronkoplastik teknikler uygulanm›flt›r. Serimizde mortalite yoktur, iki hastan›n ise yaralanmalar› ta - n›namam›fl, bunlardan biri 1. ay, di¤eri 3. ayda bronkoplastik tekniklerle onar›lm›flt›r. Serimizdeki hastalar›n 8’i (%53) 17 yafl›n alt›ndayd›. Trakeobronfliyal yaralanma insidans›m›z, ayn› sürede izlenen 1100 (eriflkin= 902, çocuk= 198) toraks travmal› hastam›z göz önüne al›nd›¤›nda %1.4’tür. Eriflkinlerdeki ve çocuklardaki insidans ise ard›fl›k olarak %0.7 ve 4’tür. Özellikle çocuklardaki de¤er literatüre göre yüksektir. Bunu da trafik ve ifl kazalar›n›n ülkemizde yüksek olmas›na ba¤ - lamaktay›z. Bu yaralanmalar %20’ye varan oranlarda atlanabilmektedir ve ortalama 3 ay içinde hastalar geri gelmektedirler. Bronfl yaralanmas› flüphesi devam etti¤i sürece bronkoskopi tekrar›ndan çekinilmemelidir. Vasküler ve parenkima hasar›n›n efllik etmedi¤i, hayati tehlike göstermeyen bronfl rüptürlerinde, majör rezeksiyonlardan kaç›n›lmal›, gerekirse durum stabilleflince bronfl rüptürleri gecikmifl olarak onar›lmal›d›r.

This study is aimed to assess the patients, who had tracheobronchial injury and to discuss the difficulties either in diagnosis or treat - ment, between 1994 and 2001.

Records of 15 patients were investigated retrospectively. Etiology of trauma, physical findings, diagnostic measures, location of the injuries and treatment options were evaluated.

The youngest patient was 1 and the oldest one was 58 years old. The median age was 15 years. Blunt trauma was the major etio - logic factor (87%). Bronchoscopy was performed in 13 patients for diagnosis. Computerized tomography (CT) is not performed rou - tinely in blunt thoracic trauma, therefore, it was performed in 4 patients who had late atelectasis (n=2) and mediastinal emphysema (n=2). Five of the patients were operated urgently, five were operated within 24 hours, three were followed conservatively and lesions in two patients were repaired in a delayed fashion. Bronchoplastic procedures were applied commonly (62%). We had no mortality. Lesions of the two patients were recognized lately and one of them was operated one month, the other was operated three months later by bronchoplastic techniques.

Eight (53%) of the patients in our series were under 17 years. Our tracheobronchial trauma incidence was 1.4% in 1100 (adult=902, pediatric=198) patients who had thoracic trauma at the same period. Incidence of tracheobronchial trauma for adults and for pediatric patients were 0.7% and 4 respectively. Particularly, the incidence in pediatric patients is higher than mentioned in the lit - erature and it is probably due to higher rates of traffic and labor accidents in our country.

These kind of injuries might be underdiagnosed at a ratio of 20% and most of these patients are admitted to hospital within 3 months. Repeated bronchoscopies should be performed in the suspected cases. Anatomic resections should avoided, in patients who do not have lethal vascular and paranchymal damage. Under these circumstances “delayed repair” should be the procedure of choice.