気道へのSengstaken-Blakemoreチューブによる疑われる気管支の異所性損傷

[Iatrogenic Injury of the Bronchus Suspiciously Caused by Sengstaken-Blakemore Tube into the Airway].

• Ken Onodera
• Nobuyuki Sato
• Kazuma Kobayashi

抄録

背景:

気管支損傷は死亡率が高いリスクがあるため、緊急に手術を行うことが多い。しかし、小さな損傷であれば保存的管理で回復することもある。

BACKGROUND: Tracheobronchial injury is often operated urgently because of the risk of high mortality. However, small injuries can recover by conservative management.

症例:

65 歳の男性が食道バリックスに対して経カテーテル動脈塞栓療法を施行した。嘔吐し，Sengstaken-Blake-moreチューブが挿入できないため内視鏡的硬化療法を行った．その後，CTで縦隔気腫と左主気管支の損傷を検出した．当科を受診し，気管支鏡検査で左主気管支裂傷を検出した．裂傷は膜状部に限定され，炎症反応は改善していたため，保存的治療が選択された．数週間後、CTと気管支鏡検査で左主気管支の損傷からの回復が確認された。

CASE: A 65-year-old man was treated for esophageal varix with transcatheter arterial embolization therapy. He vomited blood and endoscopic sclerotherapy was performed because a Sengstaken-Blake-more tube could not be inserted. Thereafter, computed tomography( CT) detected mediastinal emphysema and an injury to his left main bronchus. The patient consulted our department and bronchoscopy detected a laceration of the left main bronchus. Conservative management was chosen because the laceration was limited to the membranous portion, with the improvement of inflammatory reaction. Several weeks later, CT and bronchoscopy confirmed recovery from the injury of the left main bronchus without stricture.

結論:

多くの気管支損傷には手術が適応されます。しかし、中には保存的管理で回復するものもあります。手術の適応は、気管支鏡所見や炎症反応の進行度などを考慮して検討することが重要である。

CONCLUSION: An operation is indicated for many tracheobronchial injuries. However, some injuries can recover with conservative management. It is important that indication for surgery should be considered based on bronchoscopic findings and the progress of inflammatory reaction.