Trakeobronşiyal Yaralanmalar
Özet
Trakeobronşiyal yaralanmalar, toraks travmalarının nadir fakat hayati tehlike arz eden sonuçlarıdır. Yaralanmalar, genellikle motorlu taşıt kazaları veya ateşli silah yaralanmaları gibi künt travmalar sonucu ortaya çıkar. Klinik olarak en sık pnömotoraks, pnömomediastinum ve cilt altı amfizem ile kendini gösterir. Bu tür yaralanmaların tanısı zordur; çünkü erken dönem semptomları hafif olabilir. Kesin tanı bronkoskopik değerlendirme ile konur. Tedavi yöntemi genellikle cerrahidir ve erken müdahale, başarı oranını artırır. Cerrahi sırasında primer tamir veya anastomoz işlemleri yapılır, komplikasyonları önlemek için gergin olmayan anastomoz hattı oluşturulmalıdır. Postoperatif dönemde, stenoz ve enfeksiyon risklerini azaltmak için dikkatli bir takip gereklidir.
Tracheobronchial injuries are rare but life-threatening outcomes of thoracic trauma. These injuries typically occur due to blunt trauma, such as motor vehicle accidents or gunshot wounds. Clinically, they most commonly present with pneumothorax, pneumomediastinum, and subcutaneous emphysema. Diagnosis of such injuries can be challenging because early symptoms may be mild. The definitive diagnosis is made through bronchoscopic evaluation. Treatment is usually surgical, and early intervention increases the success rate. During surgery, primary repair or anastomosis procedures are performed, with attention to creating a tension-free anastomotic line to prevent complications. In the postoperative period, careful monitoring is essential to reduce the risks of stenosis and infection.
Referanslar
Grewal HS, Dangayach NS, Ahmad U, et al. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019;155(3):595-604. doi: 10.1016/j.chest.2018.07.018
Moser JB, Stefanidis K, Vlahos I. Imaging Evaluation of Tracheobronchial Injuries. Radiographics. 2020;40(2):515-528. doi:10.1148/rg.2020190171
Dogrul BN, Kiliccalan I, Asci ES, et al. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020;23(3):125-138. doi: 10.1016/j.cjtee.2020.04.003
Roxburgh J C. Rupture of the tracheobronchial tree. Thorax. 1987; 42: 681-8
Rossbach MM, Johnson SB, Gomez MA et al. Management of Major Tracheobronchial Injuries: A 28-Year Experience. Ann Thorac Surg. 1998; 65: 182-6
Rice DC. Surgery of the Trachea and Bronchi. Ann Surg. 2006 Jul;244(1):158. doi: 10.1097/01.sla.0000226043.56534.fe. PMCID: PMC1570594.
Magno M. Comparative anatomy of the tracheobronchial circulation. Eur Respir J Suppl. 1990; 12:557s-563s.
Schibilsky D, Driessen A, White WJ, et al. Traumatic tracheobronchial injuries: incidence and outcome of 136.389 patients derived from the DGU traumaregister. Sci Rep. 2020;10(1):20555. Published 2020 Nov 25. doi:10.1038/s41598-020-77613-x
Schneider T, Volz K, Dienemann H, et al. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg. 2009;8(5):571-576. doi:10.1510/icvts.2008.196790
Saleh ME, Beshir H, Mohammed WH, et al. Tracheobronchial injuries: tertiary center experience. Asian Cardiovasc Thorac Ann. 2020;28(1):22-28. doi:10.1177/0218492319893822
Shemmeri E, Vallières E. Blunt Tracheobronchial Trauma. Thorac Surg Clin. 2018;28(3):429-434. doi: 10.1016/j.thorsurg.2018.04.008
Schneider T, Storz K, Dienemann H, et al. Management of iatrogenic tracheobronchial injuries: a retrospective analysis of 29 cases. Ann Thorac Surg. 2007;83(6):1960-1964. doi: 10.1016/j.athoracsur.2007.01.042
Rossbach MM, Johnson SB, Gomez MA, et al. Management of major tracheobronchial injuries: a 28-year experience. Ann Thorac Surg. 1998;65(1):182-186. doi:10.1016/s0003-4975(97)01001-1
Welter S. Repair of tracheobronchial injuries. Thorac Surg Clin. 2014;24(1):41-50. doi: 10.1016/j.thorsurg.2013.10.006
Richardson JD. Outcome of tracheobronchial injuries: a long-term perspective. J Trauma. 2004;56(1):30-36. doi:10.1097/01.TA.0000108631.72315.78
Carretta A, Melloni G, Bandiera A, et al. Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. World J Surg. 2011;35(11):2568-2574. Doi:10.1007/s00268-011-1227-z
Glazer ES, Meyerson SL. Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma. J Surg Educ. 2008;65(4):302-308. doi: 10.1016/j.jsurg.2008.06.006
Balci AE, Eren N, Eren S, et al. Surgical treatment of post-traumatic tracheobronchial injuries: 14-year experience. Eur J Cardiothorac Surg. 2002;22(6):984-989. doi:10.1016/s1010-7940(02)00591-2
Huei TJ, Lip HTC, Rahmat O. Major tracheobronchial injuries: Management of two rare cases. Med J Malaysia. 2018;73(3):177-179.
Saad R Jr, Gonçalves R, Dorgan V Neto, et al. Tracheobronchial injuries in chest trauma: a 17-year experience. Rev Col Bras Cir. 2017;44(2):194-201. doi:10.1590/0100-69912017002014
Karpitski A, Shestiuk A, Panko S, et al. Thoracoscopic treatment of iatrogenic injuries of the tracheobronchial tree: a retrospective analysis of 5 cases and review of the literature. Wideochir Inne Tech Maloinwazyjne. 2022;17(1):240-244. doi:10.5114/wiitm.2021.107816
Martin de Nicolás JL, Gámez AP, Cruz F, et al. Long tracheobronchial and esophageal rupture after blunt chest trauma: injury by airway bursting. Ann Thorac Surg. 1996;62(1):269-272. doi:10.1016/0003-4975(96)00299-8
Mironov AV, Kreĭmer VD, Abakumov MM, et al. Trakheobronkhoskopiia pri raneniiakh grudi i shei [Tracheobronchoscopy in injuries of the thorax and neck]. Khirurgiia (Mosk). 1999;(9):61-63.
Tiran B, Parluk T, Kleinhendler E, et al. Fiberoptic Bronchoscopic Submucosal Injection of Mitomycin C for Recurrent Bening Tracheal Stenosis: A Case Series. Isr Med Assoc J. 2020;22(12):757-760.
Referanslar
Grewal HS, Dangayach NS, Ahmad U, et al. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019;155(3):595-604. doi: 10.1016/j.chest.2018.07.018
Moser JB, Stefanidis K, Vlahos I. Imaging Evaluation of Tracheobronchial Injuries. Radiographics. 2020;40(2):515-528. doi:10.1148/rg.2020190171
Dogrul BN, Kiliccalan I, Asci ES, et al. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020;23(3):125-138. doi: 10.1016/j.cjtee.2020.04.003
Roxburgh J C. Rupture of the tracheobronchial tree. Thorax. 1987; 42: 681-8
Rossbach MM, Johnson SB, Gomez MA et al. Management of Major Tracheobronchial Injuries: A 28-Year Experience. Ann Thorac Surg. 1998; 65: 182-6
Rice DC. Surgery of the Trachea and Bronchi. Ann Surg. 2006 Jul;244(1):158. doi: 10.1097/01.sla.0000226043.56534.fe. PMCID: PMC1570594.
Magno M. Comparative anatomy of the tracheobronchial circulation. Eur Respir J Suppl. 1990; 12:557s-563s.
Schibilsky D, Driessen A, White WJ, et al. Traumatic tracheobronchial injuries: incidence and outcome of 136.389 patients derived from the DGU traumaregister. Sci Rep. 2020;10(1):20555. Published 2020 Nov 25. doi:10.1038/s41598-020-77613-x
Schneider T, Volz K, Dienemann H, et al. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg. 2009;8(5):571-576. doi:10.1510/icvts.2008.196790
Saleh ME, Beshir H, Mohammed WH, et al. Tracheobronchial injuries: tertiary center experience. Asian Cardiovasc Thorac Ann. 2020;28(1):22-28. doi:10.1177/0218492319893822
Shemmeri E, Vallières E. Blunt Tracheobronchial Trauma. Thorac Surg Clin. 2018;28(3):429-434. doi: 10.1016/j.thorsurg.2018.04.008
Schneider T, Storz K, Dienemann H, et al. Management of iatrogenic tracheobronchial injuries: a retrospective analysis of 29 cases. Ann Thorac Surg. 2007;83(6):1960-1964. doi: 10.1016/j.athoracsur.2007.01.042
Rossbach MM, Johnson SB, Gomez MA, et al. Management of major tracheobronchial injuries: a 28-year experience. Ann Thorac Surg. 1998;65(1):182-186. doi:10.1016/s0003-4975(97)01001-1
Welter S. Repair of tracheobronchial injuries. Thorac Surg Clin. 2014;24(1):41-50. doi: 10.1016/j.thorsurg.2013.10.006
Richardson JD. Outcome of tracheobronchial injuries: a long-term perspective. J Trauma. 2004;56(1):30-36. doi:10.1097/01.TA.0000108631.72315.78
Carretta A, Melloni G, Bandiera A, et al. Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. World J Surg. 2011;35(11):2568-2574. Doi:10.1007/s00268-011-1227-z
Glazer ES, Meyerson SL. Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma. J Surg Educ. 2008;65(4):302-308. doi: 10.1016/j.jsurg.2008.06.006
Balci AE, Eren N, Eren S, et al. Surgical treatment of post-traumatic tracheobronchial injuries: 14-year experience. Eur J Cardiothorac Surg. 2002;22(6):984-989. doi:10.1016/s1010-7940(02)00591-2
Huei TJ, Lip HTC, Rahmat O. Major tracheobronchial injuries: Management of two rare cases. Med J Malaysia. 2018;73(3):177-179.
Saad R Jr, Gonçalves R, Dorgan V Neto, et al. Tracheobronchial injuries in chest trauma: a 17-year experience. Rev Col Bras Cir. 2017;44(2):194-201. doi:10.1590/0100-69912017002014
Karpitski A, Shestiuk A, Panko S, et al. Thoracoscopic treatment of iatrogenic injuries of the tracheobronchial tree: a retrospective analysis of 5 cases and review of the literature. Wideochir Inne Tech Maloinwazyjne. 2022;17(1):240-244. doi:10.5114/wiitm.2021.107816
Martin de Nicolás JL, Gámez AP, Cruz F, et al. Long tracheobronchial and esophageal rupture after blunt chest trauma: injury by airway bursting. Ann Thorac Surg. 1996;62(1):269-272. doi:10.1016/0003-4975(96)00299-8
Mironov AV, Kreĭmer VD, Abakumov MM, et al. Trakheobronkhoskopiia pri raneniiakh grudi i shei [Tracheobronchoscopy in injuries of the thorax and neck]. Khirurgiia (Mosk). 1999;(9):61-63.
Tiran B, Parluk T, Kleinhendler E, et al. Fiberoptic Bronchoscopic Submucosal Injection of Mitomycin C for Recurrent Bening Tracheal Stenosis: A Case Series. Isr Med Assoc J. 2020;22(12):757-760.
