Randell T, Söderholm A L, Lindqvist C
Department of Anesthesia, Helsinki University Central Hospital, Finland.
Arch Otolaryngol Head Neck Surg. 1992 Jul;118(7):725-8. doi: 10.1001/archotol.1992.01880070055011.
A retrospective study of problems of postoperative airway maintenance after surgery for mandibular cancers was conducted. Twenty-seven patients treated in an intensive care unit after mandibular resection and primary reconstruction were included. The mean duration of nasotracheal intubation in 22 patients was 33.7 hours. Reintubation because of breathing difficulties was required in four cases. In one of these cases, failed intubation led to an emergency cricothyroidostomy. Failure to perform reintubation resulted in the death of one patient. One patient was tracheostomized after 5 days of nasotracheal intubation. Prolonged nasotracheal intubation after major surgery for oral malignant neoplasms may be an alternative to tracheostomy, provided that adequate monitoring is available after extubation. The safe duration of endotracheal intubation is difficult to determine. Primary reconstruction does not eliminate the need for an artificial airway after tumor surgery.
对下颌癌手术后气道维持问题进行了一项回顾性研究。纳入了27例接受下颌骨切除及一期重建后在重症监护病房治疗的患者。22例患者的鼻气管插管平均时长为33.7小时。4例因呼吸困难需要再次插管。其中1例插管失败导致紧急环甲膜切开术。未进行再次插管导致1例患者死亡。1例患者在鼻气管插管5天后进行了气管切开术。口腔恶性肿瘤大手术后延长鼻气管插管时间可能是气管切开术的一种替代方法，前提是拔管后有足够的监测。气管内插管的安全时长难以确定。一期重建并不能消除肿瘤手术后对人工气道的需求。
