Succo G, Crosetti E, Pecorari G C, Nadalin J, Ragona R, Donadio P P, Terragni P P, Sartoris A
I Clinica Otorinolaringoiatrica, Università di Torino.
Acta Otorhinolaryngol Ital. 2002 Aug;22(4 Suppl 71):1-11.
The tracheotomy, one of the oldest surgical procedures, has in recent years been the focus of particular attention given the undoubted, and not always justified, increase in indications, and by the introduction of dilatational tracheotomy techniques, particularly in critically patients. The present work compares the standard surgical tracheotomy with the more recent percutaneous techniques (Ciaglia dilatational tracheotomy and Fantoni translaryngeal tracheotomy). In particular, the relationship between the technique adopted, timing and complications were analyzed for 215 tracheotomies performed at different Intensive Care Units at our Hospital between 1993 and 1998 (106 performed using the standard surgical technique, 51 with the Ciaglia technique and 58 with the Fantoni technique). The pre-operative oro-tracheal intubation time ranged between 4-54 days (17 tracheotomies performed before oro-tracheal intubation). The results of this study showed that percutaneous techniques present fewer early post-operative complications (severe bleeding, erosive stomitis, dislocation of the cannula) and above all fewer sequelae in time (tracheal stenosis, tracheomalacia). The surgical procedures are shorter and nursing is limited to a few days which certainly results in a savings in health care resources. After decannulation, the esthetic result in patients that underwent the dilatational tracheotomy can be considered excellent. Among the disadvantages one must recall the possible dislocation of the cannula immediately after surgery: forced reinsertion of the cannula exposes the patient to the risk of creating a dangerous false route. The results obtained are statistically significant and in line with those found in the literature. The conclusion is drawn that, when performed by skilled surgeons and aided by endoscopy, the percutaneous tracheotomy techniques are the method of choice for patients in critical areas.
气管切开术是最古老的外科手术之一，近年来，鉴于其适应证无疑且往往不合理地增加，以及扩张性气管切开术技术的引入，尤其是在重症患者中的应用，它一直备受特别关注。本研究将标准外科气管切开术与更新的经皮技术（Ciaglia扩张性气管切开术和Fantoni经喉气管切开术）进行了比较。特别是，分析了1993年至1998年在我院不同重症监护病房进行的215例气管切开术所采用的技术、时机与并发症之间的关系（106例采用标准外科技术，51例采用Ciaglia技术，58例采用Fantoni技术）。术前经口气管插管时间为4 - 54天（17例气管切开术在经口气管插管前进行）。本研究结果表明，经皮技术术后早期并发症（严重出血、糜烂性口腔炎、套管移位）较少，最重要的是远期后遗症（气管狭窄、气管软化）较少。手术操作时间较短，护理时间仅限于几天，这无疑节省了医疗资源。拔管后，接受扩张性气管切开术的患者的美学效果可被认为是极佳的。缺点之一是必须注意术后套管可能立即移位：强行重新插入套管会使患者面临形成危险假道的风险。所获得的结果具有统计学意义，且与文献中的结果一致。得出的结论是，当由熟练外科医生操作并在内镜辅助下进行时，经皮气管切开术技术是重症患者的首选方法。
