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on was finished， without any need for changing endoscopic divices. In 9 patients of our group the tentative diagnosis was confirmed by fiberoptic bronchoscopy. If there is a traumatic pneumothorax in patients with sever chest injury， which could completely be well ventilated after closed chest drainage， or the atelectasis occurred one week after chest trauma， the diagnosis of main bronchus rupture should be considered， and the fiberoptic bronchoscopy for a clear diagnosis should be done as early as possible. 2.2 Surgical treatment Choice for surgical treatment time： Once the diagnosis for the bronchus rupture is done， if the patient’s condition is available， the primary suturing and endtoend anastomosis of the bronchus should be performed as soon as possible. There are 3 advantages for this choice below：(1)In the early traumatic stage， the bronchus rupture wounds are less adhensive to the tissue around them so that the rupture ends can more easily be found more easily to do anastomosis.(2)It is only necessary to trim the two ends of fresh bronchus rupture and to cut down the inferior pulmonary ligament but to isolate bronchus so that the anastomosis could be done without tension. (3)The shorter the time of the posttraumatic atelectasis lasted， the better the vital pulmonary function recovered. As for some patients whose diagnosis could not be made in the early traumatic stage or whose bronchus anastomosis could be impossible because the patient’s condition would not be available， they will have to wait months to years for surgical treatment， if the wound lung has not been ruined， the bronchus endtoend anstomosis should be performed on these patients as well as possible. One patient of this group was well ventilated after a successful anastomosis was finished one year and 8 month later. But the pneumonectomy should be performed if there are pulmonary infection respectively occurred or the septic lesion of lung during operation. Generally speaking， the shorter the time from trauma is， the higher the occurrence of the atelectasis lung expand again， the better the lung function recover. Anesthesia intubations： It is a prerequisite for the bronchus anastomosis to assure the air exchange of patients during operation. To solve the patient’s ventilation issue， the doublelumen tube could be available. Another alternative is to insert a smallsize tracheal tube through the surgical field to the distal end of the traumatic bronchus after being connected to respiratory machine so as to keep the gas exchange in healthy and traumatic lung. 8 patients of this group with successful anastomosis were accompanied with doublelumen tube. The whole procedures were carried out smoothly. （本文图片见封三） 【Reference】 1 Gabor S，Renner H，Pinter H，et al.Indications for surgery in tracheobronchial ruptures.European Journal of Cardiothoracic Surgery，2001，20：399-404. 2 Helmy N，Platz A，Stocker P，et al.Bronchus rupture in multiply injuried patients with blunt chest trauma.European Journal of Trauma，2002，28(1)：31-34. 3 Rossbach MM，Johnson SB，Gomez MA，et al.Management of major tracheobronchial injuries： a 28year experience.Ann Thoracic Surg，1998，65：182-186. 4 Ramzy AI，Rodriguez A，Turney SZ.Management of major tracheobronchial ruptures in patients with multiple system trauma.J Trauma，1988，28：1353-1357. 5 Grant WJ，Meyers RL，Jaffe RL，et al.Tracheobronchial injuries after blunt chest trauma in childrenhidden pathology.J Pediatr Surg，1998，33：1707-1711. 6 Barmada H，Gibbons JR.Tracheobronchial injury in blunt and penetrating chest trauma.Chest，1994，106：74-78. 7 Endress C，Guyot DR，Engels JA.The “fallen lung with absent hilum” signs of complete bronchial transection.Ann Emerg Med，1991，20：317-318. 8 Hofman HS，Rettig G，radke J，et al.Iatrogenic ruptutres of the tracheobronchial tree.European Journal of Cardiothoracic Surgery，2002，21：649-652. 9 Balci AE，Eren N，Eren S，et al.Surgical treatment of posttraumatic tracheobronchial injuries： 14year experience.European Journal of Cardiothoracic Surgery，2002，22：984-989. 10 Sanambrogio L，Nosotti M，Cioffi U，et al.Extended membranous tracheobronchial rupture after tracheal intubation.Int Surg，1998，83(2)：106-107. 11 Borasio P，Ardissone F，Chiampo G.Post intubation tracheal rupture.A report on ten cases.Eur J Cardiothorac Surg，1997，12(1)：98-100. 12 Kloud H，SmolleJuettner FM，Prause G，et al.Iatrogenic ruptures of the tracheobronchial tree.Chest，1997，112：774-778. 13 Schultz SC，Hammon JR JW，Turner CS，et al.Surgical management and follow up of a complex tracheobronchial injury.Ann Thorac Surg，1999，67(3)：834-836. 上一页 [1] [2]
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