闭合性喉外伤的诊治进展

doi:10.6040/j.issn.1673-3770.0.2021.441

摘要/Abstract

摘要： 闭合性喉外伤是一种具有隐匿性、复杂的、可危及生命的损伤,可遗留严重影响生活质量的并发症。由于其早期症状无特异性,且常合并其他部位的严重损伤,早期易被漏诊或误诊。在损伤的急性期,保证和维持气道的稳定是成功救治的基础。延迟识别和不恰当的干预均会影响患者预后,导致其正常的呼吸、吞咽及发声功能恢复困难。因此需依据详细询问病史和查体、结合内镜及影像学等检查结果,必要时行颈部探查术,对损伤进行全面、准确的评估,以指导个体化治疗策略的制定。为了提高闭合性喉外伤的早期识别率,并为诊治方案的选择、相关并发症的处理提供思路,现对近年来闭合性喉损伤诊治的相关文献进行综述,针对治疗难点,总结诊治方案。

关键词: 喉外伤, 闭合性损伤, 喉气管狭窄, 气道管理

Abstract: Blunt laryngeal trauma is an insidious, complex, and life-threatening injury that can result in serious complications affecting the quality of life. Non-specific symptoms appear in the early stage of blunt laryngeal trauma, and these are often combined with severe injuries in other parts of the body. Therefore, initial misdiagnosis or delayed diagnosis may easily occur. In the acute phase of injury, having a stable airway is the cornerstone for successful treatment. Delayed recognition and inappropriate interventions can lead to poor prognosis, making the recovery to normal breathing, swallowing, and vocal function difficult. Therefore, based on detailed medical history and physical examination combined with endoscopy and imaging results, neck surgery is performed if deemed necessary to conduct a comprehensive and accurate assessment of the injury. As a result, the surgery can guide the formulation of individualized treatment strategies. To improve the early recognition rate of blunt laryngeal trauma and provide ideas for the selection of its diagnosis and treatment plan and the management of complications, this study reviews the latest relevant literature and summarizes the diagnostic and therapeutic plans of the disease according to the difficulty in management.

Key words: Laryngeal trauma, Blunt trauma, Laryngotracheal stenosis, Airway management

中图分类号:

R767.8

潘中静,吕丹. 闭合性喉外伤的诊治进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 124-131.

PAN Zhongjing, LÜ Dan. Diagnostic and therapeutic progress of blunt laryngeal trauma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(1): 124-131.

参考文献

[1] Moonsamy P, Sachdeva UM, Morse CR. Management of laryngotracheal trauma[J]. Ann Cardiothorac Surg, 2018, 7(2): 210-216. doi:10.21037/acs.2018.03.03
[2] Omakobia E, Micallef A. Approach to the patient with external laryngeal trauma: the schaefer classification[J]. otolaryngology, 2016, 6(230): 2. doi:10.4172/2161-119x.1000230
[3] 孙晓强, 黎万荣. 颈部闭合性外伤致喉及气管损伤一例[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(5): 425. doi:10.3760/cma.j.issn.1673-0860.2011.05.019 SUN Xiaoqiang, LI Wanrong. Closure traumatic injury of the throat and Trachea of a case[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2011, 46(5): 425. doi:10.3760/cma.j.issn.1673-0860.2011.05.019
[4] Sethi RKV, Khatib D, Kligerman M, et al. Laryngeal fracture presentation and management in United States emergency rooms[J]. Laryngoscope, 2019, 129(10): 2341-2346. doi:10.1002/lary.27790
[5] Pookamala S, Thakar A, Puri K, et al. Acquired subglottic Stenosis: aetiological profile and treatment results[J]. J Laryngol Otol, 2014, 128(7): 641-648. doi:10.1017/S0022215114000966
[6] Liu IY, Mendelsohn AH, Ching H, et al. Staged laryngotracheoplasty in adult laryngotracheal Stenosis: predictors of long-term decannulation[J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(3): 211-218. doi:10.1001/jamaoto.2014.3283
[7] Elias N, Thomas J, Cheng A. Management of laryngeal trauma[J]. Oral Maxillofac Surg Clin North Am, 2021, 33(3): 417-427. doi:10.1016/j.coms.2021.04.007
[8] 滕清晓, 王梅英, 付国强, 等. 颈部闭合性喉气管损伤117例[J]. 临床医学, 2009, 29(12): 101-102. doi:10.3969/j.issn.1003-3548.2009.12.063
[9] Shi JZ, Uyeda JW, Duran-Mendicuti A, et al. Multidetector CT of laryngeal injuries: principles of injury recognition[J]. Radiographics, 2019, 39(3): 879-892. doi:10.1148/rg.2019180076
[10] Byrne B, Tillman R, Johansson M. Laryngeal fracture after a stifled sneeze: a case report[J]. J Emerg Med, 2020, 58(2): e97-e98. doi:10.1016/j.jemermed.2019.11.047
[11] Jalisi S, Zoccoli M. Management of laryngeal fractures: a 10-year experience[J]. J Voice, 2011, 25(4): 473-479. doi:10.1016/j.jvoice.2009.12.008
[12] Oh JH, Min HS, Park TU, et al. Isolated cricoid fracture associated with blunt neck trauma[J]. Emerg Med J, 2007, 24(7): 505-506. doi:10.1136/emj.2007.048355
[13] 胡蓉, 徐文, 杨庆文, 等. 闭合性喉外伤伴杓区损伤的临床特征和内镜下治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(3): 256-262. doi:10.3760/cma.j.cn115330-20200509-00392 HU Rong, XU Wen, YANG Qingwen, et al. Diagnosis and endoscopic treatment of blunt laryngeal trauma with arytenoid injury[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(3): 256-262. doi:10.3760/cma.j.cn115330-20200509-00392
[14] Atkins BZ, Abbate S, Fisher SR, et al. Current management of laryngotracheal trauma: case report and literature review[J]. J Trauma, 2004, 56(1): 185-190. doi:10.1097/01.TA.0000082650.62207.92
[15] Lorenzo G, Peterson RB, Hudgins PA. Laryngeal trauma: common findings and imaging pearls[J]. Neurographics, 2013, 3(2): 92-99. doi:10.3174/ng.2130055
[16] 宫向荣, 王贵胜, 杨国健, 等. 重症喉气管闭合性损伤3例[J]. 山东大学耳鼻喉眼学报, 2012, 26(4): 55-57. GONG Xiangrong, WANG Guisheng, YANG Guojian, et al. Diagnosis and treatment of severe closed injury on the larynx and the Trachea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2012, 26(4): 55-57.
[17] Kennedy TL, Gilroy PA, Millman B, et al. Strobovideolaryngoscopy in the management of acute laryngeal trauma[J]. J Voice, 2004, 18(1): 130-137. doi:10.1016/s0892-1997(03)00082-1
[18] Comer BT, Gal TJ. Recognition and management of the spectrum of acute laryngeal trauma[J]. J Emerg Med, 2012, 43(5): e289-e293. doi:10.1016/j.jemermed.2010.05.023
[19] 马丽晶, 王军, 叶京英, 等. 闭合性喉气管损伤手术指征与手术时机的探讨[J]. 中国耳鼻咽喉头颈外科, 2011, 18(1): 33-36. doi:10.16066/j.1672-7002.2011.01.012 MA Lijing, WANG Jun, YE Jingying, et al. The indication and timing of surgical treatment for blunt laryngotracheal trauma[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2011, 18(1): 33-36. doi:10.16066/j.1672-7002.2011.01.012
[20] Becker M, Burkhardt K, Dulguerov P, et al. Imaging of the larynx and hypopharynx[J]. Eur J Radiol, 2008, 66(3): 460-479. doi:10.1016/j.ejrad.2008.03.027
[21] Kohler R, Vargas MI, Masterson K, et al. CT and MR angiography features of traumatic vascular injuries of the neck[J]. AJR Am J Roentgenol, 2011, 196(6): W800-W809. doi:10.2214/AJR.10.5735
[22] Becker M, Duboé PO, Platon A, et al. MDCT in the assessment of laryngeal trauma: value of 2D multiplanar and 3D reconstructions[J]. AJR Am J Roentgenol, 2013, 201(4): W639-W647. doi:10.2214/AJR.12.9813
[23] Fuhrman GM, Stieg FH 3rd, Buerk CA. Blunt laryngeal trauma: classification and management protocol[J]. J Trauma, 1990, 30(1): 87-92.
[24] Schaefer SD. Management of acute blunt and penetrating external laryngeal trauma[J]. Laryngoscope, 2014, 124(1): 233-244. doi:10.1002/lary.24068
[25] Verschueren DS, Bell RB, Bagheri SC, et al. Management of laryngo-tracheal injuries associated with craniomaxillofacial trauma[J]. J Oral Maxillofac Surg, 2006, 64(2): 203-214. doi:10.1016/j.joms.2005.10.034
[26] Bhojani RA, Rosenbaum DH, Dikmen E, et al. Contemporary assessment of laryngotracheal trauma[J]. J Thorac Cardiovasc Surg, 2005, 130(2): 426-432. doi:10.1016/j.jtcvs.2004.12.020
[27] Schaefer SD, Close LG. Acute management of laryngeal trauma. update[J]. Ann Otol Rhinol Laryngol, 1989, 98(2): 98-104. doi:10.1177/000348948909800203
[28] 孙建松. 闭合性喉外伤临床分析[J]. 中国耳鼻咽喉头颈外科, 2014, 21(6): 319-321. doi:10.16066/j.1672-7002.2014.06.015 SUN Jiansong. Clinical analysis of blunt laryngeal trauma[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2014, 21(6): 319-321. doi:10.16066/j.1672-7002.2014.06.015
[29] Mendis D, Anderson JA. Blunt laryngeal trauma secondary to sporting injuries[J]. J Laryngol Otol, 2017, 131(8): 728-735. doi:10.1017/S0022215117001220
[30] Jain U, McCunn M, Smith CE, et al. Management of the traumatized airway[J]. Anesthesiology, 2016, 124(1): 199-206. doi:10.1097/ALN.0000000000000903
[31] 刘志, 秦晓雯, 周凯, 等. 闭合性喉外伤的临床特征及处理方法[J]. 中国现代医学杂志, 2020, 30(4): 124-125. LIU Zhi, QIN Xiaowen, ZHOU Kai, et al. Clinical characteristics and treatment of closed laryngeal trauma[J]. China Journal of Modern Medicine, 2020, 30(4): 124-125.
[32] Pennington CL. External trauma of the larynx and Trachea. Immediate treatment and management[J]. Ann Otol Rhinol Laryngol, 1972, 81(4): 546-554. doi:10.1177/000348947208100414
[33] Pino Rivero V, González Palomino A, Pardo Romero G, et al. External severe laryngeal trauma with multiple fractures and airway compromise[J]. An Otorrinolaringol Ibero Am, 2005, 32(3): 239-244.
[34] Kahue CN, Gelbard A. Laryngeal trauma with and without tracheal separation[J]. Oper Tech Otolaryngol Head Neck Surg, 2017, 28(4): 244-251. doi:10.1016/j.otot.2017.08.009
[35] 周诗侗, 方红雁, 郑宏良. 喉返神经损伤的神经修复方法及材料研究进展[J]. 听力学及言语疾病杂志, 2020, 28(6): 703-706. doi:10.3969/j.issn.1006-7299.2020.06.021
[36] DePorre AR, Schechtman SA, Hogikyan ND, et al. Airway management and clinical outcomes in external laryngeal trauma: a case series[J]. Anesth Analg, 2019, 129(2): e52-e54. doi:10.1213/ANE.0000000000003843
[37] 中华医学会耳鼻咽喉头颈外科学分会咽喉学组, 中华医学会耳鼻咽喉头颈外科学分会嗓音学组, 中华医学会中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组. 喉气管狭窄诊断与治疗专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(6): 410-413. doi:10.3760/cma.j.issn.1673-0860.2018.06.003
[38] Monnier P, Dikkers FG, Eckel H, et al. Preoperative assessment and classification of benign laryngotracheal Stenosis: a consensus paper of the European Laryngological Society[J]. Eur Arch Otorhinolaryngol, 2015, 272(10): 2885-2896. doi:10.1007/s00405-015-3635-4
[39] 李玲, 黄志纯, 冯旭, 等. Montgomery-T型管在喉气管狭窄治疗中的应用[J]. 中国耳鼻咽喉头颈外科, 2021, 28(3): 186-188. doi:10.16066/j.1672-7002.2021.03.015
[40] 邓迪, 刘均, 李林珂, 等. 皮瓣二期重建策略应用于气管非环周缺损修复重建[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 52-57. doi: 10.6040/j.issn.1673-3770.1.2020.032 DENG Di, LIU Jun, LI Linke, et al. Two-stage reconstructive strategy using a flap for non-circumferential tracheal defects[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 52-57. doi: 10.6040/j.issn.1673-3770.1.2020.032
[41] 郭崟, 徐振明, 李洪波, 等. 喉裂开T管置入术与颈前转门肌皮瓣修复术治疗喉气管狭窄临床疗效研究[J]. 创伤与急危重病医学, 2020, 8(6): 431-433, 437. doi:10.16048/j.issn.2095-5561.2020.06.09 GUO Yin, XU Zhenming, LI Hongbo, et al. Clinical effect of T-tube insertion in laryngeal dehiscence and anterior cervical flap repair in the treatment of laryngeal Stenosis[J]. Trauma and Critical Care Medicine, 2020, 8(6): 431-433, 437. doi:10.16048/j.issn.2095-5561.2020.06.09
[42] 高鼎淇, 崔鹏程, 赵大庆, 等. 甲状软骨翼板移植治疗喉气管狭窄疗效分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(6): 326-328. doi:10.16066/j.1672-7002.2020.06.008 GAO Dingqi, CUI Pengcheng, ZHAO Daqing, et al. Therapeutic effect of thyroid alar cartilage graft in the treatment of laryngotracheal Stenosis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2020, 27(6): 326-328. doi:10.16066/j.1672-7002.2020.06.008
[43] 崔鹏程, 赵大庆, 郭志华, 等. 环气管部分切除术及其扩大术式治疗严重喉气管狭窄效果分析[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(2): 94-97. doi:10.3760/cma.j.issn.1673-0860.2020.02.003 CUI Pengcheng, ZHAO Daqing, GUO Zhihua, et al. Effect of partial cricotracheal resection and extended cricotracheal resection for severe laryngotracheal Stenosis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(2): 94-97. doi:10.3760/cma.j.issn.1673-0860.2020.02.003
[44] Jewett BS, Shockley WW, Rutledge R. External laryngeal trauma analysis of 392 patients[J]. Arch Otolaryngol Head Neck Surg, 1999, 125(8): 877-880. doi:10.1001/archotol.125.8.877
[45] Kim JP, Cho SJ, Son HY, et al. Analysis of clinical feature and management of laryngeal fracture: recent 22 case review[J]. Yonsei Med J, 2012, 53(5): 992-998. doi:10.3349/ymj.2012.53.5.992

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