Dulguerov P, Gysin C, Perneger T V, Chevrolet J C
Department of Otolaryngology-Head and Neck Surgery, University of Geneva Hospital, Switzerland.
Crit Care Med. 1999 Aug;27(8):1617-25. doi: 10.1097/00003246-199908000-00041.
To compare percutaneous with surgical tracheostomy using a meta-analysis of studies published from 1960 to 1996.
Publications obtained through a MEDLINE database search with a Boolean combination (tracheostomy or tracheotomy) and complications, with constraints for human studies and English language.
Publications addressing all peri- and postoperative complications. Studies limited to specific tracheostomy complications or containing insufficient details were excluded. Two authors independently selected the publications.
A list of relevant surgical variables and complications was compiled. Complications were divided into peri- and postoperative groups and further subclassified into severe, intermediate, and minor groups. Because most studies of percutaneous tracheostomy were published after 1985, surgical tracheostomy studies were divided into two periods: 1960 to 1984 and 1985 to 1996. The articles were analyzed independently by three investigators, and rare discrepancies were resolved through discussion and data reexamination.
Earlier surgical tracheostomy studies (n = 17; patients, 4185) have the highest rates of both peri- (8.5%) and postoperative (33%) complications. Comparison of recent surgical (n = 21; patients, 3512) and percutaneous (n = 27; patients, 1817) tracheostomy trials shows that perioperative complications are more frequent with the percutaneous technique (10% vs. 3%), whereas postoperative complications occur more often with surgical tracheotomy (10% vs. 7%). The bulk of the differences is in minor complications, except perioperative death (0.44% vs. 0.03%) and serious cardiorespiratory events (0.33% vs. 0.06%), which were higher with the percutaneous technique. Heterogeneity analysis of complication rates shows higher heterogeneity in older and surgical trials.
Percutaneous tracheostomy is associated with a higher prevalence of perioperative complications and, especially, perioperative deaths and cardiorespiratory arrests. Postoperative complication rates are higher with surgical tracheostomy.
通过对1960年至1996年发表的研究进行荟萃分析，比较经皮气管切开术和外科气管切开术。
通过MEDLINE数据库检索获得的出版物，检索词为布尔组合（气管切开术或气管造口术）及并发症，检索限定为人体研究和英文文献。
涉及所有围手术期和术后并发症的出版物。排除仅限于特定气管切开术并发症或细节不足的研究。由两位作者独立选择出版物。
编制了一份相关手术变量和并发症的清单。并发症分为围手术期和术后组，并进一步细分为严重、中度和轻度组。由于大多数经皮气管切开术的研究发表于1985年之后，外科气管切开术的研究分为两个时期：1960年至1984年和1985年至1996年。由三名研究人员独立分析文章，罕见的差异通过讨论和数据重新审查解决。
早期外科气管切开术的研究（n = 17；患者4185例）围手术期（8.5%）和术后（33%）并发症发生率最高。近期外科气管切开术（n = 21；患者3512例）和经皮气管切开术（n = 27；患者1817例）试验的比较表明，经皮技术围手术期并发症更常见（10%对3%），而外科气管切开术术后并发症更常见（10%对7%）。除围手术期死亡（0.44%对0.03%）和严重心肺事件（0.33%对0.06%）外，经皮技术的这些并发症发生率更高，差异主要在于轻度并发症。并发症发生率的异质性分析显示，在较旧的研究和外科手术试验中异质性更高。
经皮气管切开术围手术期并发症的发生率较高，尤其是围手术期死亡和心肺骤停。外科气管切开术的术后并发症发生率更高。
