Khoo S G, Rajaretnam N
Department of Otolaryngology - Head and Neck Surgery, Mater University Hospital, Dublin, Ireland.
J Laryngol Otol. 2012 Apr;126(4):435-8. doi: 10.1017/S0022215111003380. Epub 2012 Jan 30.
In an era in which percutaneous tracheostomies are frequently performed in 'suitable' necks, more technically complex cases are referred to the otolaryngologist. We describe the surgical technique used and close cooperation required in securing the airway of a morbidly obese patient.
A 52-year-old, morbidly obese man with significant comorbidities was referred for surgical tracheostomy following spinal fractures. This was complicated by a previous percutaneous dilatational tracheostomy scar. Tension-free skin advancement was not possible with a deeply plunging trachea; a vertical skin incision was dropped inferiorly to the sternum for access. A size 8 Shiley XLT Proximal Extension cuffed tracheostomy tube was inserted successfully.
We describe safe airway surgery in a morbidly obese man, and outline requirements including the use of a specially designed operating table, the need for an elongated proximal limb tracheostomy tube, and the use of a distal two-flap technique for access to a deeply plunging trachea.
在经皮气管切开术常在“合适的”颈部频繁进行的时代，技术上更复杂的病例会转诊给耳鼻喉科医生。我们描述了在确保病态肥胖患者气道安全时所采用的手术技术以及所需的密切协作。
一名52岁、患有多种严重合并症的病态肥胖男性，在脊柱骨折后被转诊接受手术气管切开术。此前的经皮扩张气管切开术瘢痕使情况变得复杂。由于气管深陷，无法进行无张力的皮肤推进；于是垂直皮肤切口向下延伸至胸骨以进行手术入路。成功插入了一根8号希利XLT近端延长带套囊气管切开管。
我们描述了对一名病态肥胖男性进行的安全气道手术，并概述了相关要求，包括使用特殊设计的手术台、需要一根加长近端肢体的气管切开管，以及使用远端双瓣技术来接近深陷的气管。
