Wang G X, Zhang F Z, Wang H, Zhao J, Li H B, Li X D, Zhang Y M, Zhang J
Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing 100045, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr 7;56(4):356-362. doi: 10.3760/cma.j.cn115330-20200515-00418.
To discuss the complications and postoperative outcomes of tracheotomy with different etiology in children. One hundred and eighty-six patients underwent tracheotomy were retrospectively analyzed from January 2016 to December 2018,including 117 males and 69 females. The children aged from 4 days to 14 years (median age 31.5months). One case was operated under local anesthesia in emergency room, 2 cases were operated under local anesthesia in pediatric intensive care unit, the rest 183 cases were operated under general anesthesia in operation room. The 186 children were divided into four groups according to their direct causes of tracheotomy. Group A(90 cases): Neuromuscular disease and severe infection,Group B(26 cases): Head and neck tumor,Group C(57 cases): Congenital malformation and upper airway obstruction,Group D(13 cases): Accidental injury. The basic information, surgical complications and postoperative outcomes were recorded and analyzed. All patients were followed up by clinic or by telephone. Spss 19.0 software was used for statistical analysis. One hundred and eighty-six patients were followed up for one to four years. 33 children lost the follow-up and 46 died. Among the 186 patients, 23 cases had emergency tracheotomy (12.4%). The rate of emergency tracheotomy in group C(16 cases, 28.1%) was higher than that in the other three groups(χ2=28.08,<0.05). The average age of patients and hospital stay in group C were significantly lower than those in the other three groups (=33.76,<0.05; =14.95,<0.05). Incision bleeding occurred in 11 cases, Subcutaneous emphysema occurred in 6 cases and accidental decannulation occurred in 10 cases (4 cases within 2 weeks and 6 after 2 weeks). Six patients underwent tracheocutaneous fistula closure operation after decannulation and the stoma healed spontaneously in other extubated children. Two patients underwent secondary tracheotomy due to accidental decannulation, and three patients underwent secondary tracheotomy for dyspnea after decannulation. In 107 cases of survival children, decannulation was successful in 65 patients and failed in 42 patients. The average duration of wearing tracheal tube was 8.8 months. The decannulation rates in the four groups were 55.6%, 45%, 69% and 77.8%, with no significant difference. The complications after tracheotomy in children are rare, and no severe complications occurred in long-term tracheotomy patients. The duration of wearing tracheal tube is related to the treatment of their primary disease.
探讨儿童不同病因气管切开术的并发症及术后转归。回顾性分析2016年1月至2018年12月行气管切开术的186例患儿，其中男117例，女69例。年龄4天至14岁（中位年龄31.5个月）。1例在急诊室局部麻醉下手术，2例在儿科重症监护病房局部麻醉下手术，其余183例在手术室全身麻醉下手术。186例患儿根据气管切开直接病因分为四组。A组（90例）：神经肌肉疾病及重症感染；B组（26例）：头颈部肿瘤；C组（57例）：先天性畸形及上气道梗阻；D组（13例）：意外伤害。记录并分析患儿基本信息、手术并发症及术后转归。所有患儿均门诊或电话随访。采用Spss 19.0软件进行统计学分析。186例患儿随访1至4年。33例失访，46例死亡。186例患儿中，23例行急诊气管切开术（12.4%）。C组急诊气管切开率（16例，28.1%）高于其他三组（χ2=28.08，P<0.05）。C组患儿平均年龄及住院时间显著低于其他三组（P=33.76，P<0.05；P=14.95，P<0.05）。术后发生切口出血11例，皮下气肿6例，意外脱管10例（2周内4例，2周后6例）。6例脱管后行气管皮肤瘘闭合术，其余拔管患儿造口自行愈合。2例因意外脱管行二次气管切开术，3例脱管后因呼吸困难行二次气管切开术。107例存活患儿中，65例拔管成功，42例失败。平均带管时间8.8个月。四组拔管率分别为55.6%、45%、69%和77.8%，差异无统计学意义。儿童气管切开术后并发症少见，长期气管切开患儿未发生严重并发症。带管时间与原发病治疗相关。
