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Tracheobronchiale Verletzungen

Klassifikation und Therapiestrategie

Tracheobronchial ruptures: classification and management

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Zusammenfassung

Hintergrund

Die tracheobronchiale Verletzung ist ein seltenes Notfallereignis mit hoher Sterblichkeit. Wir stellen an unserem Patientenkollektiv Management, Behandlungsergebnisse und eine eigene Klassifikation dieser Verletzungsart vor.

Material und Methoden

In einer retrospektiven Studie analysierten wir 24 Patienten (19–88 Jahre), die aufgrund einer tracheobronchialen Ruptur in unserem Zentrum behandelt wurden.

Ergebnisse

87% der Rupturen waren iatrogen bedingt. Zu 54% lag der Typ I (Trachealäsion ohne Karinaeinbeziehung), zu 38% der Typ II (perikarinale Läsionen/Hauptbronchus) und zu 8% der Typ III (distale Rupturen Lappen- oder Segmentbronchus) vor. 75% der Patienten wurden operativ versorgt. Wir beobachteten 22% Nahtinsuffizienzen, wobei eine Mediastinitis einen signifikanten Risikofaktor (p<0,001) darstellte. Die postoperative rupturbedingte Letalität betrug 5,5% und die Letalität der konservativ behandelten Fälle 33%.

Schussfolgerung

Anhand der vorgestellten Klassifikation können das therapeutische Vorgehen bei tracheobronchialen Verletzungen abgeleitet werden. Typ-I-Läsionen können entweder über einen rechtsthorakalen oder einen transzervikal-transtrachealen Zugang operativ versorgt werden. Die Versorgung von Typ-II- und -III-Läsionen ist hingegen nur durch die Thorakotomie möglich.

Abstract

Background

Tracheobronchial ruptures are rare surgical emergencies with significant mortality. We present management and outcome of such ruptures treated at the University of Leipzig in Germany and propose a novel therapeutic algorithm—a new classification system for stratifying treatment of patients with tracheobronchial ruptures.

Methods

We retrospectively studied 24 patients 19 to 88 years old who were treated in our institution for tracheobronchial injury.

Results

Eighty-seven percent of the injuries were caused iatrogenically. Fifty-four percent were type I injuries (isolated tracheal lesions), 38% type II (involvement of carina or main stem bronchi), and 8% type III (distal lesions of lobar or segmental bronchi). Seventy-five percent of the patients were operated via right-sided dorsolateral thoracotomy. In four (22%), insufficiency of the tracheal closure occurred, with mediastinitis possibly being a significant risk factor for this event (P<0.001). In surgically treated patients, rupture-related and overall mortality were 5.5% and 28%, respectively, whereas in medically treated patients, mortality was 33%.

Conclusion

The proposed classification of tracheobronchial injuries enables stratifying the treatment of patients with tracheobronchial ruptures. Type I lesions can be surgically closed either by a right-sided thoracotomy or transcervical-transtracheal approach. In contrast, surgical management of type II and III injuries always requires thoracotomy.

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Authors and Affiliations

  1. Zentrum für Chirurgie, Universitätsklinikum Leipzig

    S. Leinung, R. Ott & U. Eichfeld

  2. Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig

    E. Schuster

  3. Zentrum für Chirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103 , Leipzig

    S. Leinung

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  1. S. Leinung
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Correspondence to S. Leinung.

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Leinung, S., Ott, R., Schuster, E. et al. Tracheobronchiale Verletzungen. Chirurg 76, 783–788 (2005). https://doi.org/10.1007/s00104-005-1016-z

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