van Heerbeek N, Fikkers B G, van den Hoogen F J, Mollen R M, Marres H A
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Nijmegen, The Netherlands.
Am J Surg. 1999 Apr;177(4):311-5. doi: 10.1016/s0002-9610(99)00049-5.
Prospective evaluation of the percutaneous tracheostomy by the guide wire dilating forceps (GWDF) technique.
In 50 selected patients percutaneous tracheostomy with fiberscopic control was performed and evaluated.
Most percutaneous tracheostomies were performed without any adverse effect. No life-threatening complications or deaths were related to the procedure. The procedure was successful in 49 of 50 patients (98%). In 1 patient the procedure was converted to an open tracheostomy because significant bleeding occurred. Five perioperative complications, including this significant bleeding and four minor complications, occurred in 50 patients (10%). Early complications occurred in 6 of 48 patients (13%), including one significant bleeding and five minor complications. A subglottic stenosis occurred in 2 of 36 successfully decannulated patients (6%). In one case this was certainly due to prolonged endotracheal intubation.
The GWDF technique is a safe and efficient bedside alternative to open tracheostomy. Fiberscopic control is recommended to increase the safety of the procedure. Although studies of late complications are necessary, it appears to be justifiable to consider percutaneous tracheostomy for patients who require tracheostomy.
通过导丝扩张钳（GWDF）技术对经皮气管切开术进行前瞻性评估。
对50例选定患者进行了纤维镜引导下的经皮气管切开术并进行评估。
大多数经皮气管切开术实施过程中无任何不良反应。没有与该手术相关的危及生命的并发症或死亡情况。该手术在50例患者中的49例（98%）成功。1例患者因发生大量出血而改为开放性气管切开术。50例患者中发生了5例围手术期并发症，包括此次大量出血和4例轻微并发症（10%）。48例患者中有6例（13%）发生早期并发症，包括1例大量出血和5例轻微并发症。36例成功拔管患者中有2例（6%）发生声门下狭窄。其中1例肯定是由于长时间气管插管所致。
GWDF技术是一种安全有效的开放性气管切开术的床旁替代方法。建议采用纤维镜引导以提高手术安全性。尽管有必要对晚期并发症进行研究，但对于需要气管切开术的患者，考虑行经皮气管切开术似乎是合理的。
