Dommerich S, Graumüller S, Kramp B
Department of ENT, Head and Neck Surgery Otto Körner, Medical School, Rostock University.
Otolaryngol Pol. 2001;55(1):47-51.
Since Ciaglia described in 1985 the method of percutaneous dilational tracheotomy at first time, it has emerged to be a favored used technique in the treatment of critically ill patients to prevent the complications associated with prolonged translaryngeal intubation. There are currently several commercial kits for sequential dilatational percutaneous tracheotomy available. Essential advantages are the simplicity, rapidity, low risk and independence of the physician. But there are also risks for long time complications with essential disadvantages for neurologic and phoniatric rehabilitation.
From September 1997 to September 1999 we examined 168 patients with tracheostoma of three different rehabilitation centers with special attention to early rehabilitation. The examinations included an endoscopic control of the subglottic area, the stoma and the trachea until the bifurcation.
During our examinations we mainly found pathological findings in the subglottic area and the stoma himself with an important difference between the percutaneous tracheotomy and the epithelized tracheostomy.
There is a need for critical indications in performing the percutaneous tracheotomy. We propose its use for short-time only. Critically ill patients with a tracheostoma in requirement of a airway bypass more than 6 weeks should get an epithelized tracheostomy primarily.
自1985年恰利亚首次描述经皮扩张气管切开术以来，该技术已成为治疗重症患者的常用技术，以预防与长时间经喉插管相关的并发症。目前有几种用于序贯扩张经皮气管切开术的商用套件。其主要优点是操作简单、快速、风险低且无需医生依赖。但也存在长期并发症的风险，对神经和嗓音康复有重要不利影响。
从1997年9月至1999年9月，我们对三个不同康复中心的168例气管造口患者进行了检查，特别关注早期康复。检查包括对声门下区域、造口和气管直至分叉处的内镜检查。
在我们的检查中，主要在声门下区域和造口本身发现了病理结果，经皮气管切开术和上皮化气管造口术之间存在重要差异。
进行经皮气管切开术需要严格的指征。我们建议仅短期使用。气管造口且需要气道旁路超过6周的重症患者应首选上皮化气管造口术。
