Rare! Throughout! 5 -year -old children broke the trachea, 6 hours of surgery to recapture their vitality

On the evening of June 2, 2022, a 5 -year -old child with a bilateral bronchial fracture was urgently rescued by the Children's Hospital of Shandong University. The child was "a large amount of blood gas chest and subcutaneous qi, respiratory failure, multiple rib fractures, thoracic spine fractures, liver and spleen coercles" 6 days ago due to unexpected fall injuries. " Ventilation, due to the critical condition of the disease, rushed to the children's intensive care unit of the Children's Hospital of Jinan City. After turning in, it was found that the child's chest closed drainage continued to overflow a large amount of gas, suspected of the fracture of the trachea. Because the CT image failed to confirm the diagnosis, the respiratory intervention department immediately conducted a tracheal mirror examination. Lobbing. The situation is urgent and must be surgery immediately, otherwise there will be life -threatening.

Considering that the child's condition is dangerous and complicated, the medical department of the hospital organized a multi -disciplinary expert consultation and formulation of treatment plans for multi -disciplinary experts to conduct multi -disciplinary experts and other related departments such as thoracic surgery, general surgery, neurosurgery, respiratory intervention, anesthesiology, operating room and cardiac surgery. It was decided to immediately transfer the child to the cardiac surgery for repair surgery of the bilateral bronchial fracture tube, while closely observing the changes in other parts of trauma.

It is rare for children to completely tear off their bilateral trimmed bronchies at home and abroad. The injury mechanism may be that when the chest cavity is under tremendous pressure from the front and rear, the bilateral bronchium is pulled horizontally, and the bronchial fracture occurs from the ruling. Due to the falling injury, the irregularities of the trachea, the distance between the two breaks, and the high tension of the tension. In addition, there is a long time after the injury. Aiming at the treatment of bilateral bronchial fracture/laceration, if the method of freezing and left and right main bronchial pads is adopted, the ventilator may not be able to maintain breathing due to a large amount of air leakage at the broken end. Cycling assisted surgery. However, the child has the possibility of liver and spleen coercion, extravasitive hematoma, and cannot exclude delayed intracranial hemorrhage. If in vitro cycling heparin anticoagulation is used, mobility bleeding may be induced. In addition, the time after injury is relatively long. If the infection cannot be controlled after surgery, the tracheal fistula may occur or even open, which will directly threaten life in severe cases. Therefore, the children's surgery can be described as difficult.

Surgery site

The cardiac surgery team immediately launched an emergency plan for emergency surgery of crisis patients immediately after receiving the task. The first preparation preparation was made. After repeated evaluation, detailed, thorough, and efficient discussions, the surgical plan that was most suitable for children was formulated. Essence That is to use the left and right trachea sutures separately. First swim the bond and the left main bronchial, the tracheal tube enters the left main bronchial single lung ventilation after sutured the fracture, and then swim the right main bronchium for the end. In vitro circulation is the second echelon.

The operation officially started at zero. Although there are meticulous preoperative examinations and full preparations, it is more complicated to find that the child's situation is more complicated than expected. Local inflammatory response and dissection of dissection. After swimming at the rumbling place, a large amount of air leakage, the ventilator cannot maintain the moisture volume, and cannot continue surgery. Due to the age factors of the child, the tracheal freezing and telescope, and the trachea and the aorta, right pulmonary arteries, heart, and esophageal anatomy approaching, and the obstruction of organ tissue greatly affects the exposure of the trachea, so it immediately decided to enable the second echelon, that is, in vitro circulation, Continue surgery.

After full swimming, the bilateral trimmed trachea was completely torn off from the beginning. The distance between the main bronchial end of the main bronchial on the left was about 2.5cm and the right side was about 1.5cm. The two broken ends were connected by the surrounding pleural tissue. Pulling the tension tension and cannot be directly matched. In the end, with its superb technology and rich experience, after 6 hours of struggle, overcoming difficulties, the operation finally completed successfully. The child returned to the cardiac surgery monitoring room at 6 am. The postoperative blood flow dynamic indicators were stable. On the first day of the operation, the ventilator was separated. The current condition was stable.

In recent years, the construction of multi -disciplinary teams in Jinan Children's Hospital has developed rapidly, and various departments have worked closely. All medical staff cooperate closely. Cardiac surgery cooperates closely with the respiratory intervention section, actively carry out surgical treatment of congenital tracheal stenosis in children, has been unanimously recognized by domestic counterparts, and has successfully cured children from 26 provinces, municipalities, and autonomous regions across the country. Since the development of professionalism, emergency surgery of life and death at a speed of life and death has been continuously staged. All medical staff have always taken the "life priority, emergency treatment" as the standard, and "time is life" as the service concept. Children's life and health.

Reporter: Qiu Tian

Edit: Wang Jing

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