Aggarwal Sushil Kumar, Gupta Devendra, Keshri Amit, Bhavana Kranti
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India.
Int J Pediatr Otorhinolaryngol. 2012 Aug;76(8):1132-5. doi: 10.1016/j.ijporl.2012.04.016. Epub 2012 May 16.
We have designed a technique of tracheostomy in pediatric patients with S-shaped incision on the tracheal wall which we think, provides a larger cross-sectional area of stoma and facilitates easier insertion of tracheostomy tube and thus helped in reducing early and late complications associated with it in our series.
The trachea was exposed in midline by a vertical skin incision. In order to make S-shaped tracheostoma, second tracheal ring was identified. The conventional vertical incision was made in second tracheal ring and then extended at both its ends laterally in the inter-cartilaginous space parallel to the tracheal cartilage in the opposite direction to make the incision S-shaped. The trachea was dilated with tracheal dilator and appropriate size of tracheostomy tube was then placed into the trachea.
S-shaped tracheostomy was performed in 40 children with mean age of 6.36 years (age range is 2-12) required for airway maintenance or prolonged ventilatory support. The incidence of early complications was quite less in our patients (ranged from 0 to 5%). There was no incidence of excessive intra-operative bleeding or injury to surrounding structures causing subcutaneous emphysema or vocal cord palsy. One patient developing pneumothorax after the procedure was managed conservatively. There was no incidence of tracheo-esophageal fistula, suprastomal collapse or difficulty in decannulation on 9 months of follow up related to our technique. However, one of the patients developed early trachietis and cutaneous peristomal granulomas and 2 patients developed late trachietis which was treated conservatively.
S-shaped tracheoplasty, a new pediatric tracheotomy technique has resulted in a quantifiable reduction in the risk of the early and late complications in our series. Hence, we feel that this new technique is a better alternative to existing methods but larger randomized controlled studies are required before universal adoption of this technique.
我们设计了一种针对小儿患者的气管切开技术，其气管壁切口呈S形，我们认为该技术可提供更大的造口横截面积，便于气管切开管更容易插入，从而有助于减少我们系列病例中与之相关的早期和晚期并发症。
通过垂直皮肤切口在中线暴露气管。为制作S形气管造口，识别第二气管环。在第二气管环做传统的垂直切口，然后在其两端沿软骨间间隙向外侧平行于气管软骨向相反方向延伸，使切口呈S形。用气管扩张器扩张气管，然后将合适尺寸的气管切开管置入气管。
对40例平均年龄6.36岁（年龄范围2至12岁）需要气道维持或长期通气支持的儿童实施了S形气管切开术。我们的患者早期并发症发生率相当低（范围为0至5%）。没有术中出血过多或损伤周围结构导致皮下气肿或声带麻痹的情况发生。1例患者术后发生气胸，经保守治疗。在9个月的随访中，与我们的技术相关的气管食管瘘、造口上塌陷或拔管困难均未发生。然而，1例患者发生了早期气管炎和造口周围皮肤肉芽肿，2例患者发生了晚期气管炎，均经保守治疗。
S形气管成形术，一种新的小儿气管切开技术，已使我们系列病例中早期和晚期并发症的风险有了可量化的降低。因此，我们认为这项新技术是现有方法的更好替代方案，但在普遍采用这项技术之前，还需要进行更大规模的随机对照研究。
