Koshika Kyotaro, Tachibana Keikoku, Hoshino Tatsuki, Terashima Reiko, Okada Reina, Ouchi Takashi, Koitabashi Toshiya
Department of Dental Anesthesiology, Tokyo Dental College.
Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital.
Bull Tokyo Dent Coll. 2021 Dec 4;62(4):227-234. doi: 10.2209/tdcpublication.2021-0007. Epub 2021 Nov 15.
A minitracheostomy (MTS) is performed after surgery for oral cancer at our institution in patients who are at risk of postoperative airway obstruction. The aim of this study was to evaluate outcomes of preventive airway management with this procedure. A total of 105 patients undergoing preventive airway management with a Seldinger MTS kit after oral cancer surgery between October 2014 and March 2020 were enrolled. Information on patient characteristics, time required for the MTS, duration of tracheal cannula placement, and MTS-related complications was obtained from both the medical and anesthesia records. In addition, the numbers of postoperative instances of tracheotomy between April 2009 and September 2014 and extubation between October 2014 and March 2020 were also counted for a comparison. The time required for an MTS was 3.2±2.6 min. Minor complications, including mild subcutaneous or mediastinal emphysema and bleeding, were found in 5 patients, but all recovered in a short time. The median duration of tracheal cannula placement was 2 days, with a range of from 0 to 8 days. A total of 348 oral cancer surgeries were performed between April 2009 and September 2014. Among patients undergoing these procedures, 111 underwent a tracheostomy (32%), 235 extubation (68%), and 2 sustained intubation. A total of 580 oral cancer surgeries were performed between October 2014 and March 2020. Here, 121 patients underwent a tracheostomy (21%), 105 an MTS (18%), and 354 extubation (61%). The results suggest that an MTS can be performed safely and smoothly with no significant complications. They also suggest that an MTS reduces the need for a full tracheostomy and the risk of airway obstruction after extubation. We conclude that airway management strategy with an MTS is a useful option in preventing airway obstruction following oral cancer surgery.
在我们机构中，对于有术后气道阻塞风险的口腔癌患者，会在手术后进行微创气管切开术（MTS）。本研究的目的是评估采用该手术进行预防性气道管理的效果。纳入了2014年10月至2020年3月期间105例口腔癌手术后采用Seldinger MTS套件进行预防性气道管理的患者。从医疗和麻醉记录中获取患者特征、MTS所需时间、气管插管放置持续时间以及与MTS相关并发症的信息。此外，还统计了2009年4月至2014年9月期间气管切开术的术后实例数量以及2014年10月至2020年3月期间拔管的数量以作比较。MTS所需时间为3.2±2.6分钟。5例患者出现轻微并发症，包括轻度皮下或纵隔气肿及出血，但均在短时间内恢复。气管插管放置的中位持续时间为2天，范围为0至8天。2009年4月至2014年9月期间共进行了348例口腔癌手术。在接受这些手术的患者中，111例进行了气管切开术（32%），235例拔管（68%），2例持续插管。2014年10月至2020年3月期间共进行了580例口腔癌手术。在此期间，121例患者进行了气管切开术（21%），105例进行了MTS（18%），354例拔管（61%）。结果表明，MTS可以安全、顺利地进行，且无明显并发症。结果还表明，MTS减少了全气管切开术的需求以及拔管后气道阻塞的风险。我们得出结论，采用MTS的气道管理策略是预防口腔癌手术后气道阻塞的一种有用选择。
