Monnier P H, Ravussin P, Savary M, Freeman J
Clinique ORL, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Clin Otolaryngol Allied Sci. 1988 Jun;13(3):209-17. doi: 10.1111/j.1365-2273.1988.tb01120.x.
Obstructive lesions of the larynx and subglottic space are always a challenging problem for the endoscopist and anaesthetist. At this level, the efficacy and innocuity of a carbon dioxide laser treatment are related to the degree of endoscopic exposure. Thanks to the transtracheal high frequency jet ventilator, it is now possible to assure a free laryngeal endoscopic operative field. The transtracheal catheter is introduced percutaneously through the cricothyroid membrane into the trachea under endoscopic control and connected to a high frequency jet ventilator. From November 1983 to April 1985, this technique has been used in 65 cases. In 12 cases, it was the only alternative to avoid a tracheostomy. The other indications were: laryngeal papillomatosis, resection of T1a cancers of the vocal cords, fibrous strictures secondary to long term intubation, laser arytenoidectomies and benign lesions of the vocal cords. Among many advantages, the following are the most convincing: clear vision of the operative field for the surgeon, complete relaxation of the patient, good respiratory gas exchange, elimination of the risk of ignition of an endotracheal tube by laser, decreased risks of broncho-aspiration of blood and debris, and the facility to provide oxygen and/or mechanical ventilation in the postoperative period. The only complication encountered was a case of cervico-mediastinal emphysema caused by displacement of the tracheal catheter.
喉及声门下区的阻塞性病变一直是内镜医师和麻醉医师面临的具有挑战性的问题。在此层面，二氧化碳激光治疗的有效性和安全性与内镜暴露程度相关。借助经气管高频喷射通气，现在能够确保喉部内镜手术视野清晰。经气管导管在内镜控制下经皮穿过环甲膜插入气管，并连接至高频喷射通气机。1983年11月至1985年4月，该技术已应用于65例患者。在12例患者中，它是避免气管切开的唯一选择。其他适应证包括：喉乳头状瘤病、声带T1a期癌切除术、长期插管继发的纤维性狭窄、激光杓状软骨切除术以及声带良性病变。在诸多优点中，以下几点最具说服力：术者手术视野清晰、患者完全放松、呼吸气体交换良好、消除了激光点燃气管导管的风险、降低了血液和碎屑误吸至支气管的风险，以及术后便于提供氧气和/或机械通气。仅遇到1例因气管导管移位导致的颈纵隔气肿并发症。
