Moriwaki Yoshihiro, Sugiyama Mitsugi, Iwashita Masayuki, Harunari Nobuyuki, Toyoda Hiroshi, Kosuge Takayuki, Arata Shinju, Suzuki Noriyuki
Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
Am Surg. 2010 Nov;76(11):1251-4.
Tracheostomy is hardly performed in patients with cervical infection close to the site of the tracheostomy. This study aimed to present and clarify the usefulness and safety of open tracheostomy performed by the paramedian approach technique. The procedure is as follows. A 2.5-cm paramedian incision is made for the tracheostomy on the opposite side of infectious focus; the anterior neck muscles are dissected and split; the trachea is fenestrated by a reverse U-shaped incision; and the fenestral flap of the trachea is fixed to the skin. We used this technique in five patients. There were no complications such as bleeding, desaturation, and displacement of the tube; and there were no postoperative complications such as severe contamination or infection of the tracheostomy site from the nearby cervical wound, difficulty in securing the tracheostomy tube and connecting device to the ventilator, difficulties in daily management and care, or dislocation of the tracheostomy tube. All wounds resulting from the tracheostomy were kept separate from and not contaminated by the nearby dirty wounds. Open tracheostomy by the paramedian approach technique is useful and safe for patients with severe cervical infection requiring open drainage and long ventilatory management.
在靠近气管造口部位存在颈部感染的患者中，很少进行气管造口术。本研究旨在介绍并阐明经旁正中入路技术进行开放性气管造口术的实用性和安全性。手术步骤如下。在感染灶对侧做一个2.5厘米的旁正中切口用于气管造口；解剖并分开颈部前方肌肉；通过倒U形切口在气管上开窗；将气管的开窗瓣固定于皮肤。我们对5例患者采用了该技术。未出现出血、血氧饱和度下降和导管移位等并发症；也未出现术后并发症，如气管造口部位因附近颈部伤口导致的严重污染或感染、将气管造口导管及连接装置与呼吸机连接困难、日常管理和护理困难或气管造口导管脱位。气管造口造成的所有伤口均与附近的污染伤口分开，未被污染。经旁正中入路技术进行开放性气管造口术对于需要开放引流和长期通气管理的严重颈部感染患者是有用且安全的。
