Complete Transsection of the Trachea by Blunt Trauma

둔상에 의한 기관 완전 절단 - 1예 보고 -

  • Kim, Dae-Hwan (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Yoo, Byung-Ha (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Han-Yong (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hwang, Sang-Won (Department of Thoracic and Cardiovascular Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 김대환 (성균관대학교 의과대학 마산삼성병원 흉부외과) ;
  • 유병하 (성균관대학교 의과대학 마산삼성병원 흉부외과) ;
  • 김한용 (성균관대학교 의과대학 마산삼성병원 흉부외과) ;
  • 황상원 (성균관대학교 의과대학 마산삼성병원 흉부외과)
  • Published : 2007.01.05

Abstract

Tracheobronchial rupture due to blunt chest trauma is an uncommon injury although the incidence is increasing. Early diagnosis and primary repair of tracheobronchial rupture not only restore a normal lung function but also avoid the difficulties and complications associated with delayed diagnosis and repair We present one case of the tracheal transsection caused by traffic accident. Patient suffered from progressive dyspnea, subcutaneous emphysema on the neck and anterior chest wall and tension pneumothorax at both sides were noted. Although both closed thoracostomy were done, massive air leakage through the chest tube continued and subcutaneous emphysema spread to the anterior abdominal wall and scrotum and the degree of dyspnea aggravated. With the impression of tracheobronchial injury, we performed the emergency operation. Preoperative bronchoscopy at the operation room was proceeded, which revealed the trachea was near totally transsected in transverse direction. Operation was performed through collar incisiion on the anterior neck, and the trachea was anastomosed with 4-0 $Vicryl^{(R)}$ interruptedly. Postoperative course were uneventful and patient discharged without any complications.

둔상에 의한 기관-기관지 파열은 발생빈도가 낮은 질환이나, 점차 그 빈도가 증가하는 추세이다. 일단 기관-기관지 파열이 발생하면 매우 심각한 증상을 유발하여 생명의 위협을 초래하고, 많은 합병증을 야기하기 때문에 조기에 진단하여 외과적으로 치료하는 것이 바람직하다 본 저자들은 35세의 남자 환자에서 교통사고 후 발생한 기관 완전 절단의 한 예를 보고하는 바이다. 환자는 수상 후 심한 호흡곤란과 경부, 전흉부에 생긴 피하기종을 주소로 내원하여 양측 긴장성 기흉 진단하에 응급 흉관 삽관술 시행 후에도 대량의 공기 유출이 지속되었고, 피하기종은 복부와 음낭까지 진행되었으며, 호흡부전은 더욱 심화되어 기관-기관지 파열이 강력히 의심되어 응급 수술을 시행하였다. 수술실에서 시행한 술 전 기관지내시경상 성대 하에서 기관의 횡단 절단을 확인하였으며, 수술은 목에 칼라 절개를 가한 후 절단된 기관을 확인하여 4-0 바이크릴(Vicryl) 봉합사를 이용하여 단속봉합에 의한 단단 문합술을 시행하였다. 술 후 흉관을 통한 공기유출은 없었고 기관지내시경 추적 검사상 양호한 소견을 보였으며 특별한 합병증 발병 없이 퇴원하였다.

Keywords

References

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