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目的探讨陈旧性创伤性主支气管断裂的临床特征和吻合方法,提高诊断及治疗效果。方法17例陈旧性创伤性主支气管断裂患者,14例行支气管端端吻合术,2例行右肺上叶袖状切除术,1例左全肺切除术。5例用丝线或涤纶线间断全层缝合,6例用微桥线间断全层缝合,6例用prolene线行环部连续加膜部间断缝合。5例用带血管蒂的肋间肌包埋吻合口。结果围术期有3例出现胸腔积液;1例出现乳糜胸;随访2例出现刺激性咳嗽,镜下见肉芽组织增生。结论支气管纤维镜是明确陈旧性创伤性主支气管断裂诊断的重要手段;术中须彻底切除狭窄段支气管瘢痕,用prolene线行环部连续加膜部间断缝合既简化操作且临床效果满意。
Objective To explore the clinical features and anastomosis of old traumatic bronchial rupture and to improve the diagnosis and treatment effect. Methods Twenty-seven patients with old traumatic bronchus rupture, 14 patients underwent bronchial end-to-end anastomosis, 2 underwent right upper lobe sleeve resection and 1 left pneumonectomy. 5 cases were interrupted by full-thickness sutured with silk or polyester thread, 6 cases were interrupted by full-thickness suture with micro-bridge, 6 cases were treated with prolene line, and the ring was interrupted by intermittent suture. 5 cases of vascular intercostal muscle embedding anastomosis. Results Perioperative pleural effusion in 3 cases; 1 case of chylothorax; 2 cases of irritating cough, microscopic granulation tissue hyperplasia. Conclusions Bronchofiberscope is an important method to confirm the diagnosis of traumatic bronchus rupture. The stenosis of bronchial scar should be completely excised during operation. The continuous operation of prolene line and intermittent suturing of the membranous part is not only easy to operate but also satisfactory.