Oberwalder M, Weis H, Nehoda H, Kafka-Ritsch R, Bonatti H, Prommegger R, Aigner F, Profanter C
Department of General and Transplant Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Surg Endosc. 2004 May;18(5):839-42. doi: 10.1007/s00464-003-9082-0.
Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy (CB) or videobronchoscopy (VB).
Consecutive intensive care unit (ICU) patients who underwent PDT were enrolled in this study. Videobronchoscopy was available in two ICUs, whereas CB was available in three ICUs. Demographic data, procedural variables, and complications were recorded.
In this study, 36 patients underwent PDT guided by VB (group V), and 38 patients underwent PDT guided by CB (group C). The two groups were well matched in terms of gender, anatomic aspects, and positioning of the patient. Operating time, procedural difficulty, and extent of tracheal bleeding were not different between the two groups. Group V showed a tendency to younger age (p = 0.055). Surgeons significantly more often considered PTD to be "completely safe" in group V (92% vs 61% in group C). The skin incisions were smaller (p = 0.003), and the extent of stomal bleeding was less (p = 0.001). Complications were tendentiously less frequent in group V (5.5%) than in group C (23.7%; p = 0.062).
The surgeon performing PDT guided by VB has a higher degree of safety, resulting in less bleeding than with PDT guided by CB.
经皮扩张气管切开术（PDT）可在传统支气管镜或视频支气管镜引导下进行。只有后一种操作能为外科医生提供直接的视觉信息。本研究前瞻性评估了传统支气管镜（CB）或视频支气管镜（VB）引导下PDT的操作参数和并发症。
连续纳入接受PDT的重症监护病房（ICU）患者。两个ICU配备有视频支气管镜，而三个ICU配备有传统支气管镜。记录人口统计学数据、操作变量和并发症。
本研究中，36例患者在VB引导下接受PDT（V组），38例患者在CB引导下接受PDT（C组）。两组在性别、解剖学特征和患者体位方面匹配良好。两组的手术时间、操作难度和气管出血程度无差异。V组患者年龄有更年轻的趋势（p = 0.055）。V组外科医生更常认为PTD“完全安全”（92%对C组的61%）。皮肤切口更小（p = 0.003），造口出血程度更轻（p = 0.001）。V组并发症发生率有低于C组的趋势（5.5%对23.7%；p = 0.062）。
与CB引导下的PDT相比，VB引导下进行PDT时外科医生的安全性更高，出血更少。
