内镜手术中颈内动脉损伤管理方案的制定：改良 Delphi 法和单中心多学科工作组。
Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group.
机构信息
Department of Otolaryngology - Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 401, Toronto, ON, M5G 1X5, Canada.
Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada.
出版信息
J Otolaryngol Head Neck Surg. 2022 Jul 28;51(1):30. doi: 10.1186/s40463-022-00582-w.
BACKGROUND
Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct vessel closure, and endovascular techniques have been described as useful strategies for managing ICA bleeds. The objective of this study was to develop a formalized management protocol for intra-operative ICA injury through engagement with a multi-disciplinary panel.
METHODS
A modified Delphi method including literature review, iterative rounds of stakeholder feedback, and expert panel discussions was used to develop a management protocol for ICA injury during transnasal endoscopic surgery. The 10-person multi-disciplinary panel included otolaryngologists, neurosurgeons, interventional neuroradiologists, anesthesiologists, and operating room nursing staff.
RESULTS
After three rounds of stakeholder engagement with the expert panel, consensus was reached on important elements to include within the protocol. The protocol was divided in three categories: Alert, Control, and Transfer. 'Alert' focusses on early communication with anesthesia and nursing staff. 'Control' focusses on techniques to expose the injury and obtain hemostasis or adequate tamponade. Lastly, 'Transfer' describes the process of contacting neuro-interventional radiology and safely transferring the patient. A one-page handout of the protocol was developed for placement in operating theatres.
CONCLUSION
Due to the life-threatening nature of ICA injury, it is imperative that endoscopic sinus and skull base surgeons are prepared to manage this complication. Using a modified Delphi method with a multidisciplinary expert panel, a protocol for management of intra-operative ICA injury was developed.
背景
经鼻内镜手术过程中颈内动脉（ICA）损伤是一种潜在的灾难性事件。这种损伤在即刻情况下危及生命，据报道围手术期死亡率为 10%。鼻腔填塞、肌肉贴片、直接血管闭合和血管内技术已被描述为处理 ICA 出血的有用策略。本研究的目的是通过多学科小组的参与，制定经鼻内镜手术过程中 ICA 损伤的规范化管理方案。
方法
采用改良 Delphi 法，包括文献复习、利益相关者反馈的迭代回合和专家小组讨论，制定经鼻内镜手术过程中 ICA 损伤的管理方案。该 10 人多学科小组包括耳鼻喉科医生、神经外科医生、介入神经放射科医生、麻醉师和手术室护理人员。
结果
经过三轮利益相关者与专家小组的接触，就协议中应包括的重要内容达成了共识。该方案分为三个类别：“Alert”，重点关注与麻醉和护理人员的早期沟通；“Control”，重点关注暴露损伤和获得止血或充分填塞的技术；最后，“Transfer”描述了联系神经介入放射科并安全转移患者的过程。制定了一份协议的单页传单，放置在手术室。
结论
由于 ICA 损伤的生命威胁性质，内镜鼻窦和颅底外科医生必须准备好处理这种并发症。使用改良 Delphi 法和多学科专家小组，制定了 ICA 损伤术中管理的方案。
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