Rozsasi Ajnacska, Kühnemann Stephan, Gronau Silke, Keck Tilman
Department of Otorhinolaryngology - Head and Neck Surgery, University Medical School Ulm, Germany.
Int J Pediatr Otorhinolaryngol. 2005 May;69(5):607-13. doi: 10.1016/j.ijporl.2004.11.024. Epub 2005 Jan 20.
Among a wide variety of tracheostomy techniques, a vertical tracheal incision and a horizontal incision with creation of an inferior base tracheal flap have been favorized in children in the past. The aim of this study was to determine surgical and postoperative stoma complications after performing these two types of tracheal incision in tracheostomy in children.
A 6-year, prospective, observational cohort study was undertaken in 24 children (range, 0.03 month-15 years) at the Department of Otorhinolaryngology, University of Ulm. All children who underwent an elective tracheostomy were included in this study. Early and late local disorders in wound healing of the tracheal stoma and the clinical follow-up of both groups (Flap group and Vertical group) were analyzed.
Formation of granulation tissue and tracheal stenosis were the most observed local disorders in both groups. Granulation tissue at the level of the stoma was the most frequently observed complication in the Flap group (4/12; 33%), whereas in the Vertical group only one child showed granulation tissue around the stoma (1/7; 14%). The difference between both groups was statistically not significant. The overall mortality rate 1 year after tracheostomy was 25% (6/24) and the tracheostomy-related death rate was 4% (1/24). An association of wound healing disorders with a feasible lethal outcome was not found after both tracheostomy types. There were no differences in the outcome between both tracheal incision types.
Both types of tracheal incision proved to be a suitable surgical procedure for temporary or permanent tracheostomy in pediatric patients.
在众多气管切开术技术中，过去垂直气管切口和带有下基底气管瓣的水平切口在儿童中更受青睐。本研究的目的是确定在儿童气管切开术中施行这两种气管切口后的手术及术后造口并发症情况。
在乌尔姆大学耳鼻喉科对24名儿童（年龄范围0.03个月至15岁）进行了一项为期6年的前瞻性观察队列研究。所有接受择期气管切开术的儿童均纳入本研究。分析了两组（瓣组和垂直组）气管造口伤口愈合的早期和晚期局部病变以及临床随访情况。
两组中最常观察到的局部病变是肉芽组织形成和气管狭窄。造口处的肉芽组织是瓣组中最常观察到的并发症（4/12；33%），而在垂直组中只有一名儿童在造口周围出现肉芽组织（1/7；14%）。两组之间的差异无统计学意义。气管切开术后1年的总死亡率为25%（6/24），与气管切开术相关的死亡率为4%（1/24）。两种气管切开术后均未发现伤口愈合障碍与可能的致命结局之间存在关联。两种气管切口类型的结果没有差异。
两种气管切口类型均被证明是儿科患者临时或永久性气管切开术的合适手术方法。
