Yuan J J, Li D P, Liu Y H, Wu K L, Zhao Y, Wu J, Yao C Y, Wang Y
Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Zhonghua Zhong Liu Za Zhi. 2020 Nov 23;42(11):976-979. doi: 10.3760/cma.j.cn112152-20200418-00354.
To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer. A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Different treatments were carried out according to different complications. The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea. Patients with dyspnea immediately received ventilator-assisted ventilation. For those with massive hemorrhage on the wound, doctors should prevent bleeding and stop bleeding under general anesthesia. Patients with severely coughing should perform eating training to prevent food aspiration. The inner cannula was regularly replaced once a month for all of these patients. Through targeted treatment, the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled. After dressing change, the neck wounds of 31 patients with neck infection were shrunk or healed. Finally, all of the patients were replaced with metal tracheal tubes. Eight cases with dyspnea were rescued with the symptomatic and related special treatment, and finally replace by metal tracheal tube. Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula. Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula. The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryngeal or hypopharyngeal cancer. It is strongly recommended that the operators should fully understand and use it reasonably after the operation of laryngeal or hypopharyngeal cancer.
探讨带内套管的气管切开套管在喉癌及下咽癌术后并发症治疗中的应用策略及效果。共有60例喉癌及下咽癌患者出现严重术后并发症,其中术后颈部严重感染31例、呼吸困难8例、大出血5例、严重顽固性误吸16例。立即为这些患者佩戴带内套管和外气囊的气管套管并充气。根据不同并发症进行不同治疗。对于颈部严重感染患者,将外气囊充气以防止大量颈部分泌物吸入气管。呼吸困难患者立即接受呼吸机辅助通气。对于伤口大出血患者,医生应在全身麻醉下预防出血并止血。严重呛咳患者应进行进食训练以防止食物误吸。所有患者每月定期更换一次内套管。通过针对性治疗,60例带内套管的气管切开套管患者的并发症得到有效控制。换药后,31例颈部感染患者的颈部伤口缩小或愈合。最后,所有患者均更换为金属气管套管。8例呼吸困难患者经对症及相关特殊治疗后获救,最终更换为金属气管套管。5例颈部伤口大出血患者成功获救并更换为金属气管套管。16例顽固性误吸患者中有13例拔除气管套管,另外3例年老病重患者更换为金属气管套管。带内套管的气管切开套管在喉癌或下咽癌术后严重并发症的治疗中具有重要价值。强烈建议手术者在喉癌或下咽癌手术后充分了解并合理使用。