Tracheobronchiale Verletzungen

Zusammenfassung

Tracheobronchiale Verletzungen sind selten, gehen aber mit einer hohen Morbidität und Letalität einher. Dies liegt vor allem in Nebenerkrankungen und Begleitverletzungen der Patienten begründet. Eine grundsätzliche Klassifikation differenziert tracheobronchiale Verletzungen nach iatrogener Ursache sowie stumpfen wie auch penetrierenden Traumata.

Die genaue Inzidenz der Verletzungen ist unklar, da viele iatrogene Verletzungen inapparent verlaufen und ein Großteil der Patienten nach einer traumatischen Verletzung vor einer Behandlung im Krankenhaus verstirbt.

Patienten mit Verdacht auf eine tracheobronchiale Verletzung verlangen daher nach besonderer Aufmerksamkeit, einer schnellen Diagnostik und zügigem therapeutischem Vorgehen.

Die häufigsten Symptome sind Dyspnoe, Hämoptysen, Hautemphysem und Stridor. Die Bronchoskopie stellt die wichtigste diagnostische Maßnahme zur Beurteilung des Ausmaßes der Verletzung dar.

In Abhängigkeit der diagnostischen Befunde und dem klinischen Erscheinungsbild der Patienten gibt es verschiedene therapeutische Optionen, wobei das konservative Management an Bedeutung gewinnt. Gerade bei schwerstkranken Patienten kann im Rahmen eines risikostratifizierten Vorgehens neben einem operativen Eingriff oder einer bronchoskopischen Stentimplantation auch ein rein konservatives Vorgehen gewählt werden. Zur Planung des therapeutischen Managements ist bei jedem Patienten die jeweilige Symptomatik wegweisend.

Abstract

Tracheobronchial injury is a rare, but potentially life-threatening condition. These injuries are associated with high morbidity and mortality, which is ascribed to underlying diseases and additional injuries. Lacerations of the airway are differentiated into iatrogenic and non-iatrogenic injuries, while the group of non-iatrogenic lesions are grouped into blunt and penetrating traumas.

The exact incidence of tracheobronchial injury is unknown, because many iatrogenic injuries occur without symptoms and most patients after traumatic laceration die before inpatient treatment. All patients with suspicion of airway injury require fast and accurate management.

Common signs and symptoms are dyspnoea, haemoptysis, stridor and subcutaneous emphysema.

Bronchoscopy is the most important tool for diagnosis and in several cases also for initial treatment.

Further management depends on the patient’s clinical condition and findings of bronchoscopy and computed tomography. Surgery has been the cornerstone of therapy, but in selected patients bronchoscopic stent implantation or conservative management must be discussed.

Schlüsselwörter

Thoraxchirurgie - Trachea - Tracheaverletzung

Keywords

thoracic surgery - tracheal surgery - tracheal injuries

Publication History

Received: 25 July 2023

Accepted after revision: 26 September 2023

Article published online:
26 October 2023

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