Paleczny J, Maciejewski D, Łoniewska-Paleczny E, Sawczuk M, Kaczur A
Oddziału Anestezjologii i Intensywnej Terapii Szpitala Ogólnego im. prof. N. Cybulskiego w Bielsku-Białej.
Wiad Lek. 2000;53(9-10):552-61.
The purpose of this study was to compare on the basis of up to date papers currently applied methods of the percutaneous tracheostomy (PT). There are four main PT methods by: Ciaglia, Schachner, Griggs and Fantoni. In these methods a wire is introduced into the trachea serving as a guide for special forceps or series of dilatators of increasing diameter to dilate the wall and allow cannulation of the trachea. In the literature authors found a low incidence of complications after PT. Acute complications were documented in 6-18% and late complications in 1-3% of the patients. Follow-up showed no late obstructive complications at the level of stomia and very low (0.3-0.36%) mortality risk. Translaryngeal tracheostomy (TLT) by Fantoni ensures minimal risk of complications and tissue trauma. In the TLT method through a needle inserted in to the trachea a guide wire is retrogradely pushed out of the mouth and attached to special flexible tracheostomy tube by flexible plastic cone with pointed metal tip. This device is then pulled back through larynx and outwards across the trachea and neck wall by traction on the wire. TLT can also be used in infants and children and in difficult patients in whom other techniques are riskier Review of the literature suggests that the PT can be safe and also cost-effective for properly selected patients in intensive care and other hospital units.
本研究的目的是根据最新文献，比较目前应用的经皮气管切开术（PT）方法。主要有四种PT方法：Ciaglia法、Schachner法、Griggs法和Fantoni法。在这些方法中，将一根导丝插入气管，作为特殊钳子或一系列直径逐渐增大的扩张器的引导，以扩张气管壁并实现气管插管。作者在文献中发现PT术后并发症发生率较低。6% - 18%的患者出现急性并发症，1% - 3%的患者出现晚期并发症。随访显示，造口处无晚期梗阻性并发症，死亡风险极低（0.3% - 0.36%）。Fantoni经喉气管切开术（TLT）确保并发症和组织创伤风险最小。在TLT方法中，通过插入气管的针将导丝逆行推出口腔，并通过带有金属尖的柔性塑料锥连接到特殊的柔性气管切开管上。然后通过牵拉导丝，将该装置拉回穿过喉部并向外穿过气管和颈部壁。TLT也可用于婴儿和儿童以及其他技术风险更高的困难患者。文献综述表明，对于重症监护病房和其他医院科室中经过适当选择的患者，PT可以是安全且具有成本效益的。
