Lin J C, Maley R H, Landreneau R J
Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Ann Thorac Surg. 2000 Oct;70(4):1194-6. doi: 10.1016/s0003-4975(00)01504-6.
An extensive posterior-lateral longitudinal tracheal laceration is an uncommon but serious complication of percutaneous dilational tracheostomy (PDT). We report the successful management of three ventilator-dependent patients whose percutaneous tracheostomy was complicated by an extensive longitudinal posterior-lateral tracheal laceration requiring operative repair.
A retrospective review of 134 cases of PDT with concurrent bronchoscopy was performed between April 1997 and July 1999 and compared with a review of 124 cases of open tracheostomy. Tracheal lacerations were primarily repaired and augmented with intercostal muscle pedicle buttress.
Three cases of an extensive posterior-lateral longitudinal tracheal laceration that required operative repair were reported in the PDT group. None were reported in the open tracheostomy group. The 3 patients were managed with an adult high-frequency oscillating ventilator or pressure control ventilation during the postoperative period to limit barotrauma, and all healed without evidence of tracheal leak or stenosis.
The increasing popularity of PDT, particularly among nonsurgical disciplines, may generate an increasing number of complications requiring operative attention. Thoracic surgeons need to be cognizant of the pitfalls of PDT technique and be prepared to manage these difficult clinical scenarios.
广泛的气管后外侧纵行撕裂是经皮扩张气管切开术（PDT）一种罕见但严重的并发症。我们报告了3例依赖呼吸机的患者，他们的经皮气管切开术并发广泛的气管后外侧纵行撕裂，需要手术修复，最终成功治愈。
对1997年4月至1999年7月间134例行PDT并同期行支气管镜检查的病例进行回顾性分析，并与124例开放性气管切开术病例进行比较。气管撕裂主要采用肋间肌蒂支撑修复并加强。
PDT组报告了3例需要手术修复的广泛气管后外侧纵行撕裂病例。开放性气管切开术组未报告此类病例。3例患者术后使用成人高频振荡呼吸机或压力控制通气以限制气压伤，均愈合，无气管漏气或狭窄迹象。
PDT越来越普及，尤其是在非外科领域，这可能导致需要手术处理的并发症数量增加。胸外科医生需要认识到PDT技术的陷阱，并准备好处理这些困难的临床情况。
