[Tracheobronchial injuries--experience with diagnosis and therapy].

The incidence of penetrating injuries of the respiratory pathways is permanently low and relatively stable, on the other hand, it may be assumed that there is an increasing rate of tracheobronchial injuries during blunt accidents of the chest in particular in conjunction with the increased rate of traffic injuries. Serious injuries are involved, in particular because of their high morbidity and mortality; frequently they are part of associated injuries and polytraumas. In 1999-2002 at the Surgical Clinic of the Plzen-Lochotín Faculty Hospital a penetrating stab wound of the cervical trachea was treated in an 11-year-old boy and injuries of the large bronchi of adult men resulting from blunt chest injuries during car accidents. All three injuries were associated with a typical symptomatology of pneumocolon and pneumomediastinum, or persistent pneumothorax and respiratory complaints resp. The definite diagnosis was established in two instances shortly after admission, based on results of CT and bronchoscopic examination, in the case of the injury of the middle bronchus only on the following day during surgical revision combined with preoperative bronchoscopy. Treatment was surgical in all instances. Twice the lesion was sutured, in one case pulmonary resection was performed. No significant postoperative complications were observed nor any deaths. The main factors which influence in a decisive way the prognosis of the casualty and the therapeutic result are in the authors' opinion, consistent with data in the literature, early assessment of the diagnosis of tracheobronchial injury and early adequate therapeutic action. In the diagnosis a dominant position is held in addition to CT in particular by treacheobronchoscopy. In case of surgical treatment reconstruction operations are preferred.