Succo G, Crosetti E, Mattalia P, Voltolina M, Bramardi F, Di Lisi D, Riva F, Sartoris A
I Clinica Otorinolaringoiatrica, Università di Torino.
Acta Otorhinolaryngol Ital. 2002 Aug;22(4 Suppl 71):12-8.
Dilatational tracheotomy techniques are widely used in the long-term management of the respiratory tract in patients in intensive care units (ICU). The translaryngeal tracheotomy technique (TLT) was first described by Fantoni in 1993 and rapidly asserted itself, especially in Europe. This technique basically differs from the other percutaneous techniques in that it involves a progressive, retrograde, dilatation of the trachea in a single session conducted from inside the trachea, working outward, simultaneously exerting a counter-pressure on the pre-tracheal soft tissues with the fingers. The present study involves an endoscopy follow-up of 130 patients who had undergone TLT at the Intensive Care Unit of our Hospital between November 2000 and May 2001. The pre-operative oro-tracheal intubation time varied from 1 to 42 days. All patients filled out a brief questionnaire containing validated questions on their general health and quality of life with particular attention focused on respiratory conditions. Then, after receiving informed consent, the patients underwent laryngo-tracheoscopy with local anesthetic using a flexible tracheobronchoscope. All tests were recorded and viewed later by two operators in order to identify and divide the patients according to the level of execution of the tracheotomy and the presence of sequelae. The results obtained have shown that, like other percutaneous tracheotomy techniques, TLT provides some benefits including the fact that procedure can be performed at the bedside in a short time, with few post-operative complications, simpler nursing and fewer sequelae in time. Analysis of data concerning time of tracheostomy execution, tracheal level of stomia and nursing times has revealed three factors that determine severe sequelae: delay in tracheostomy execution, high level of execution with cricoid involvement and onset of problems during first tracheal cannula change.
扩张性气管切开术技术广泛应用于重症监护病房（ICU）患者呼吸道的长期管理。经喉气管切开术（TLT）由法托尼于1993年首次描述，并迅速得到认可，尤其是在欧洲。该技术与其他经皮技术的基本区别在于，它在单次操作中从气管内部向外部进行渐进性、逆行性气管扩张，同时用手指对气管前软组织施加反压。本研究对2000年11月至2001年5月期间在我院重症监护病房接受TLT的130例患者进行了内镜随访。术前经口气管插管时间为1至42天。所有患者填写了一份简短问卷，其中包含关于他们总体健康和生活质量的有效问题，特别关注呼吸状况。然后，在获得知情同意后，患者使用可弯曲支气管镜在局部麻醉下接受喉气管镜检查。所有检查均进行记录，随后由两名操作人员查看，以便根据气管切开术的执行水平和后遗症的存在对患者进行识别和分类。获得的结果表明，与其他经皮气管切开术技术一样，TLT具有一些益处，包括该手术可在床边短时间内完成，术后并发症少，护理更简单，后遗症也较少。对气管切开术执行时间、造口气管水平和护理时间的数据分析揭示了决定严重后遗症的三个因素：气管切开术执行延迟、环状软骨受累的高执行水平以及首次更换气管套管期间出现问题。
