nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2024-13-1-99-107nmp-1796Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSИнструментальный разрыв трахеиInstrumental Tracheal Rupturehttps://orcid.org/0000-0002-4437-2696ХачатрянС. А.KhachatryanS. A.

Хачатрян Сурен Арутюнович - врач-торакальный хирург, торакальное хирургическое отделение ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».

129090, Москва, Б. Сухаревская пл., д. 3

Suren A. Khachatryan - Thoracic Surgeon, Thoracic Surgery Department.

3, Bolshaya Sukharevskaya Sq., Moscow 129090

khachatryan.suro250@gmail.comhttps://orcid.org/0000-0002-1159-5367ЧерноусовФ. А.ChernousovF. A.

Черноусов Федор Александрович - доктор медицинских наук, профессор, ведущий научный сотрудник отделения неотложной хирургии, эндоскопии и интенсивной терапии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».

129090, Москва, Б. Сухаревская пл., д. 3

Fyodor A. Chernousov - Doctor of Medical Sciences, Professor, Leading Researcher of the Department of Emergency Surgery, Endoscopy and Intensive Care.

3, Bolshaya Sukharevskaya Sq., Moscow 129090

fchernousov@mail.ruДаниелянШ. Н.DanielyanSh. N.

Даниелян Шаген Николаевич - доктор медицинских наук, ведущий научный сотрудник отделения неотложной хирургии, эндоскопии и интенсивной терапии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ»/

129090, Москва, Б. Сухаревская пл., д. 3

Shagen N. Danielyan - Doctor of Medical Sciences, Leading Researcher at the Department of Emergency Surgery, Endoscopy and Intensive Care.

3, Bolshaya Sukharevskaya Sq., Moscow 129090

shdanielyan@gmail.comГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation20241504202413199107Copyright © Хачатрян С.А., Черноусов Ф.А., Даниелян Ш.Н., 20242024Хачатрян С.А., Черноусов Ф.А., Даниелян Ш.Н.Khachatryan S.A., Chernousov F.A., Danielyan S.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1796

Резюме Разрыв трахеи неотложное жизнеугрожающее осложнение, относящееся к сложным и малоосвещенным разделам хирургии повреждений. В статье представлен обзор современной мировой и отечественной литературы, посвященный инструментальным разрывам трахеи, актуальности ранней диагностики и различных методов лечения. На основании анализа современных данных литературы в статье описаны вопросы консервативного и хирургического методов лечения, а также оценка их результатов. Проблема диагностического алгоритма и выбора консервативного, хирургического метода лечения не решена и сохраняет свою Актуальность. Вопросы лечения пациентов при выявлении дефекта мембранозной стенки трахеи реанимационного профиля и нуждавшихся в искусственной вентиляции легких в клинической практике остаются нерешенными. Все вышесказанное свидетельствует об актуальности проведенного исследования.

Цель исследования Представить данные отечественной и зарубежной литературы, посвященной диагностике и лечению инструментальных разрывов трахеи.

Материал и методы Выполнен обзор литературы за период с 1993 по 2024 год на русском и английском языках, доступной на базах Pubmed, Medline, UpTodate, Scopus, E-library, по таким темам, как постинтубационный разрыв трахеи, ятрогенный разрыв трахеи, диагностика и лечение инструментальных разрывов трахеи, закрытая травма трахеи.

Результаты Изложена концепция системы классификации, факторы риска, этиопатогенез. Приведены сведения о диагностической значимости компьютерной томографии и трахеобронхоскопии. Пристальное внимание уделено методам и выбору тактики лечения, принципам интраоперационной тактики, стратегии консервативного лечения. Дана сравнительная оценка результатов лечения и их осложнений при консервативном или хирургическом подходе лечения.

Заключение Таким образом, анализ отечественной и зарубежной литературы свидетельствует о том, что вопросы диагностики и лечения ятрогенных повреждений трахеи во многом остаются нерешенными. Нет общепринятого алгоритма инструментальной диагностики разрывов трахеи. Нет единых подходов к определению показаний и противопоказаний к консервативному и хирургическому лечению повреждений трахеи. В вопросе выбора лечебной тактики существуют диаметрально противоположные мнения. Эти противоречия создают существенные трудности в оценке результатов лечения этой сложной категории пациентов.

Abstract Tracheal rupture is an urgent life-threatening complication that relates to complex and poorly understood areas of trauma surgery. The article presents a review of modern world and domestic literature on instrumental tracheal ruptures, the Relevance of early diagnosis and various treatment methods. Based on an analysis of modern literature data, the article describes the issues of conservative and surgical treatment methods, as well as an assessment of their results. The problem of the diagnostic algorithm and the choice of conservative, surgical treatment has not been solved and remains relevant. The issues of treating patients with a defect in the membranous wall of the trachea in intensive care and in need of artificial ventilation in clinical practice remain unresolved. All of the above indicates the Relevance of the study.

Aim of the study To present data from domestic and foreign literature on the diagnosis and treatment of instrumental tracheal ruptures.

Material and methods A review of the literature was carried out for the period from 1993 to 2024 in Russian and English, available on the databases Pubmed, Medline, UpTodate, Scopus, E-library, on topics such as post-intubation tracheal rupture, iatrogenic tracheal rupture, diagnosis and treatment of instrumental tracheal ruptures, closed tracheal injury.

Results The concept of the classification system, risk factors, etiopathogenesis is outlined. Information is provided on the diagnostic significance of computed tomography and tracheobronchoscopy. Close attention is paid to the methods and choice of treatment tactics, the principles of intraoperative tactics, and the strategy of conservative treatment. A comparative assessment of treatment Results and their complications with a conservative or surgical treatment approach is given.

Conclusion Thus, an analysis of domestic and foreign literature indicates that the issues of diagnosis and treatment of iatrogenic tracheal injuries remain largely unresolved. There is no generally accepted algorithm for instrumental diagnosis of tracheal ruptures. There are no uniform approaches to determining indications and contraindications for conservative and surgical treatment of tracheal injuries. There are diametrically opposed opinions regarding the choice of treatment tactics. These contradictions create significant difficulties in assessing the Results of treatment of this complex category of patients.

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The authors declare that there are no conflicts of interest present.