Reeker W, Sader R, Hauck R, Kochs E
Institut für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1999 Oct;34(10):665-7. doi: 10.1055/s-1999-217.
Recently, the Translaryngeal Tracheostomy (TLT) has been developed by Fantoni [1,2]. This new technique has been suggested for long-term ventilated intensive care patients as an alternative to other minimal invasive tracheostomy techniques like the Percutaneous Dilatational Tracheostomy described by Ciaglia [3] or Griggs [4]. In comparison to these techniques, the main advantage of the TLT seems to be the access to the airway from inside the trachea to outside. This procedure minimizes the risk of luxations of parts of the tracheal wall into the tracheal lumen resulting in obstructive ventilatory problems. The often discussed risk of stomal infections associated with this technique due to a possible bacterial contamination of the mouth seems not to be clinically relevant. In the past minimal invasive tracheostomy techniques have only been recommended for patients with normal anatomical conditions and without any special risk factors. The present case report describes the successful performance of a TLT in a patient with a severe M. Bechterew and respiratory failure due to a Guillain-Barré-syndrome. This patient was at high risk for operative complications during a conventional surgical tracheostomy due to his underlying diseases.
最近，法托尼研发出了经喉气管切开术（TLT）[1,2]。对于长期接受机械通气的重症监护患者，这项新技术被推荐作为其他微创气管切开术的替代方法，如恰利亚[3]或格里格斯[4]所描述的经皮扩张气管切开术。与这些技术相比，经喉气管切开术的主要优势似乎在于从气管内部通向外部的气道通路。该手术将气管壁部分突入气管腔导致通气障碍问题的风险降至最低。由于口腔可能受到细菌污染而常被讨论的与该技术相关的造口感染风险在临床上似乎并不相关。过去，微创气管切开术仅推荐用于解剖结构正常且无任何特殊风险因素的患者。本病例报告描述了在一名因吉兰 - 巴雷综合征导致严重贝赫切特病和呼吸衰竭的患者中成功实施经喉气管切开术的情况。由于该患者的基础疾病，在进行传统外科气管切开术时发生手术并发症的风险很高。
