Michna B A, Krummel T M, Tracy T, Brooks J W, Salzberg A M
Division of Pediatric, Medical College of Virginia, Richmond.
Ann Thorac Surg. 1988 May;45(5):541-3. doi: 10.1016/s0003-4975(10)64528-6.
Historically, tracheostomy has been used for infants with airway obstruction caused by congenital or acquired subglottic stenosis. Postoperative morbidity and mortality with this provisional operation led Cotton, in 1980, to substitute anterior cricoid split as the primary definitive procedure. Within the past three years, anterior cricoid split has been performed in 4 infants, aged 3 to 9 months, with acquired (3 patients) or congenital (1 patient) subglottic stenosis requiring ventilation through an endotracheal tube. Following cricoid split, the trachea is stented for 12 to 14 days by a nasotracheal tube, with extubation and rigid bronchoscopy in the operating room with the patient under anesthesia to confirm healing and patency. During an 18- to 24-month follow-up in these 4 patients, morbidity has been minimal, patency has persisted, and stridor has not recurred. Accordingly, a conclusive operation, cricoid split, rather than a temporizing tracheostomy may be employed for certain obstructive tracheal lesions early in life.
从历史上看，气管切开术一直用于患有先天性或后天性声门下狭窄引起气道阻塞的婴儿。这种临时手术的术后发病率和死亡率促使科顿在1980年用环状软骨前部劈开术替代气管切开术作为主要的确定性手术。在过去三年中，对4例年龄在3至9个月、患有后天性（3例）或先天性（1例）声门下狭窄且需要通过气管内插管进行通气的婴儿实施了环状软骨前部劈开术。环状软骨劈开术后，通过鼻气管导管对气管进行12至14天的支架置入，然后在手术室对处于麻醉状态的患者进行拔管和硬质支气管镜检查，以确认愈合情况和通畅性。在对这4例患者进行18至24个月的随访期间，发病率极低，气道保持通畅，喘鸣未复发。因此，对于某些生命早期的阻塞性气管病变，可采用确定性手术——环状软骨劈开术，而非临时性气管切开术。
