Kennedy Maeve M, Abdel-Aty Yassmeen, Lott David G
Head and Neck Regenerative Medicine Laboratory, Center for Regenerative Medicine, Mayo Clinic Arizona, 13400 East Shea Blvd., Scottsdale, AZ 85259, United States of America.
Division of Laryngology, Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd., Phoenix, AZ 85054, United States of America.
Am J Otolaryngol. 2021 Nov-Dec;42(6):103030. doi: 10.1016/j.amjoto.2021.103030. Epub 2021 Apr 7.
Various operative techniques are used to perform tracheostomies. The objective of this study was to evaluate patient factors that influence the decision to perform a Bjork flap or a window.
A retrospective review was conducted of all patients who underwent tracheostomies from January 2015 to December 2019 at a tertiary care medical center. All patients underwent tracheostomy with either a Bjork flap or a window. Charts were reviewed for demographics, comorbidities, indication for tracheostomy, operative details, and complications.
A total of 217 tracheostomies were evaluated, of which 104 (47.9%) had a Bjork flap and 113 (52.1%) had a window. Bjork flap was significantly more likely to be performed in patients with a higher average body mass index (p = 0.05), requiring ventilatory support (p = 0.0001), or had a stroke (p = 0.0140). A window was used significantly more in patients with prior neck dissection (p = 0.0110) or neck radiation (p < 0.0001). No significant difference was observed for post-op bleeding, returning to the operating room, or days to decannulation. In all tracheostomies, thrombocytopenia was found to significantly correlate with post-op bleeding (p = 0.0006), while blood thinner use did not.
Bjork flaps were more likely to be performed in those with a history of prolonged mechanical ventilation and elevated body mass index. Windows were performed more frequently in patients with a head and neck cancer history. Future prospective studies are needed to compare the outcomes of these techniques and their impacts on the trachea long term.
多种手术技术可用于实施气管切开术。本研究的目的是评估影响施行比约克瓣或开窗术决策的患者因素。
对2015年1月至2019年12月在一家三级医疗中心接受气管切开术的所有患者进行回顾性研究。所有患者均接受了比约克瓣或开窗术的气管切开术。查阅病历以获取人口统计学资料、合并症、气管切开术的指征、手术细节和并发症。
共评估了217例气管切开术，其中104例（47.9%）采用了比约克瓣，113例（52.1%）采用了开窗术。在平均体重指数较高（p = 0.05）、需要通气支持（p = 0.0001）或患有中风（p = 0.0140）的患者中，施行比约克瓣的可能性显著更高。在既往有颈部淋巴结清扫术（p = 0.0110）或颈部放疗史（p < 0.0001）的患者中，开窗术的使用显著更多。术后出血、返回手术室或拔管天数方面未观察到显著差异。在所有气管切开术中，发现血小板减少症与术后出血显著相关（p = 0.0006），而使用血液稀释剂则无此关联。
有长期机械通气史和体重指数升高的患者更有可能施行比约克瓣。有头颈癌病史的患者更频繁地施行开窗术。未来需要进行前瞻性研究以比较这些技术的结果及其对气管的长期影响。
