Moriwaki Yoshihiro, Katoh Makoto, Toyoda Hiroshi, Kosuge Takayuki, Arata Shinju, Iwashita Masayuki, Suzuki Noriyuki
Yokohama City University Medical Center, Yokohama, Japan.
Kyobu Geka. 2012 Feb;65(2):119-23.
Forty eight year-old woman with untreated liver cirrhosis was transferred to our critical care and emergency center because of airway crisis due to retropharyngo-esophageal hematoma after slight chest contusion. We performed emergency tracheal intubation beyond stenotic part of the trachea. The hematoma did not diminished in a few days. Although we considered tracheostomy, we hesitated to perform conventional median tracheostomy because of the risk of complication of infection of the hematoma which might require drainage or removal resulting in contamination between tracheostomy site and cervical wound. We performed paramedian tracheostomy by antero-lateral skin incision to avoid these risks. Fortunately, the patient did not require drainage of the retropharyngo-esophageal hematoma. Paramedian tracheostomy should be taken into account for patients with presumably contaminated cervical wound.
一名48岁未治疗的肝硬化女性因轻微胸部挫伤后发生咽后食管血肿导致气道危机，被转至我们的重症监护和急救中心。我们在气管狭窄部位上方进行了紧急气管插管。血肿在数天内并未消退。尽管我们考虑过气管切开术，但由于存在血肿感染并发症的风险，可能需要引流或清除，这会导致气管切开部位与颈部伤口之间的污染，所以我们对进行传统的正中气管切开术犹豫不决。我们通过前外侧皮肤切口进行了旁正中气管切开术以避免这些风险。幸运的是，患者无需对咽后食管血肿进行引流。对于推测颈部伤口已被污染的患者，应考虑行旁正中气管切开术。
