Elő Gábor, Zubek László, Hargitai Zoltán, Iványi Zsolt, Branovics Judit, Gál János
Interv Med Appl Sci. 2012 Dec;4(4):206-9. doi: 10.1556/IMAS.4.2012.4.5. Epub 2012 Dec 27.
Tracheal stenosis is the most common severe late complication of percutaneous tracheostomy causing significant decrease in quality of life. Applying modified Griggs technique reduced the number of late tracheal stenoses observed in our clinical study. The aim of this study was to investigate the mechanism of this relationship.
Forty-six cadavers were randomized into two groups according to the mode of intervention during 2006-2008. Traditional versus modified Griggs technique was applied in the two groups consequently. Wider incision, surgical preparation, and bidirectional forceps dilation of tracheal wall were applied in modified technique. Injured cartilages were inspected by sight and touch consequently. Age, gender, level of intervention, and number of injured tracheal cartilages were registered.
Significantly less frequent tracheal cartilage injury was observed after modified (9%) than original (91%) Griggs technique (p < 0.001). A moderate association between cartilage injury and increasing age was observed, whereas the level of intervention (p = 0.445) and to gender (p = 0.35) was not related to injury. Risk of cartilage injury decreased significantly (OR: 0.0264, 95%, CI: 0.005-0.153) with modified Griggs technique as determined in adjusted logistic regression model.
Modified Griggs technique decreased the risk of tracheal cartilage injury significantly in our cadaver study. This observation may explain the decreased number of late tracheal stenosis after application of the modified Griggs method.
气管狭窄是经皮气管切开术最常见的严重晚期并发症，会导致生活质量显著下降。应用改良的格里格斯技术可减少我们临床研究中观察到的晚期气管狭窄数量。本研究的目的是探讨这种关系的机制。
2006年至2008年期间，根据干预方式将46具尸体随机分为两组。两组分别采用传统与改良的格里格斯技术。改良技术采用更宽的切口、手术准备以及气管壁的双向钳扩张。随后通过视觉和触觉检查受损软骨。记录年龄、性别、干预水平和受损气管软骨数量。
改良的（9%）格里格斯技术后观察到的气管软骨损伤频率显著低于原始的（91%）（p < 0.001）。观察到软骨损伤与年龄增长之间存在中度关联，而干预水平（p = 0.445）和性别（p = 0.35）与损伤无关。在调整后的逻辑回归模型中，改良的格里格斯技术使软骨损伤风险显著降低（OR：0.0264，95%，CI：0.005 - 0.153）。
在我们的尸体研究中，改良的格里格斯技术显著降低了气管软骨损伤的风险。这一观察结果可能解释了应用改良的格里格斯方法后晚期气管狭窄数量减少的原因。
