Goldenberg D, Ari E G, Golz A, Danino J, Netzer A, Joachims H Z
Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and Technion Faculty of Medicine, Haifa, Israel.
Otolaryngol Head Neck Surg. 2000 Oct;123(4):495-500. doi: 10.1067/mhn.2000.105714.
Tracheotomy is one of the most frequently performed surgical procedures in the critically ill patient. It is frequently performed as an elective therapeutic procedure and only rarely as an emergency procedure. Complications occur in 5% to 40% of tracheotomies depending on study design, patient follow-up, and the definition of the different complications. The mortality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severely ill patients, and in small children.
A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studied the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths.
In total, 1130 tracheotomies were performed. Major complications occurred in 49 of the cases, and 8 deaths were directly attributed to the tracheotomy. The most common complication was tracheal stenosis, which occurred in 21 cases. Hemorrhage was the second most common complication, which occurred in 9 cases.
This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common complication in contrast to other series. Our opinion is that this may reflect tracheal damage originally caused by prolonged intubation before the tracheotomy. We believe that all other complications of tracheotomy may be prevented or minimized by careful surgical technique and postoperative tracheotomy care.
气管切开术是重症患者最常施行的外科手术之一。它常作为择期治疗手术进行，极少作为急诊手术。根据研究设计、患者随访情况以及不同并发症的定义，气管切开术的并发症发生率在5%至40%之间。气管切开术的死亡率低于2%。大量研究表明，在紧急情况、重症患者以及小儿中，并发症和死亡率更高。
对10年间（1987年1月至1996年12月）连续施行的1130例气管切开术进行回顾性研究。我们研究了手术指征、气管切开术的主要并发症及其治疗和结局。我们还记录了总体死亡率以及导致这些死亡的具体并发症。
总共施行1130例气管切开术。49例发生了主要并发症，8例死亡直接归因于气管切开术。最常见的并发症是气管狭窄，共发生21例。出血是第二常见的并发症，共发生9例。
这是汇编的最大系列连续气管切开术之一。与其他大型系列研究相比，我们发现总体并发症和死亡率相对较低。与其他系列不同，气管狭窄是最常见的并发症。我们认为，这可能反映了气管切开术前长时间插管最初造成的气管损伤。我们相信，通过仔细的手术技巧和术后气管切开护理，气管切开术的所有其他并发症都可以预防或降至最低。
